Magnetic Resonance Imaging Captures the Biology of Ductal Carcinoma In Situ

Abstract

The heterogeneous presentation of DCIS on MRI reflects underlying histopathologic differences.

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

“…The average concentration of gadolinium in ducts measured in our study was high enough to be a substantial source of measured signal in clinical DCE MR imaging. This may partly explain the typical morphology of DCIS lesions on clinical DCE MR images: non-masslike ductal rather than periductal enhancement in a segmental and/or linear distribution (4,8,25). In addition, the higher v e of DCIS and the likely longer timeframe of gadolinium exchange into and out of ducts may explain the persistent and plateau curve types often found for DCIS (25)(26)(27)(28)(29).…”

“…Because DCIS is the earliest stage of breast cancer and has the best prognosis, it is likely that further improvements in the detection of breast cancers at a preinvasive stage may improve patient outcomes. Some reports have shown decreased diagnostic accuracy of DCE MR imaging for DCIS (2,3), while others have shown comparable or even higher performance compared with that of x-ray mammography (4,5). The sensitivity of DCE MR imaging for detection of DCIS may be compromised if the lesion does not exhibit sufficient gadolinium uptake or if it is obscured by strongly enhancing parenchyma (6,7).…”

Clinically Meaningful Tumor Reduction Rates Vary by Prechemotherapy MRI Phenotype and Tumor Subtype in the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657)

“…False-positive MRI enhancement may reflect a spectrum of change within high-risk tissue, possibly explaining why it is difficult to distinguish residual tumor size in ER-positive patients, especially with diffuse disease. 39,40 We previously reported differences in response to NAC based on the five MRI phenotypes described. Patients with well-circumscribed masses had the greatest response to NAC.…”

An “elite hacker”

“…[83][84][85][91][92][93] The altered microenvironment can, depending on the individual tumor location, genetics and systematic influences, increase ECM stiffening, vascularity, breast tissue density and/or result in calcifications potentially to the level of detection by mammographic screening or MRI. [94][95][96][97] Indeed, the introduction of routine mammographic screening artificially elevated the "incidence" of DCIS, and arguably has led to its overtreatment. 98 Eventually, the cells within the DCIS breach the myoepithelial layer and the basement membrane, defining the moment when an invasive breast carcinoma is formed.…”