MR features to suggest microinvasive ductal carcinoma of the breast: can it be differentiated from pure DCIS?

Abstract

Non-mass lesions with segmental distribution, heterogeneous enhancement, and strong initial enhancement with a wash-out curve were the dominant MRI findings of microinvasive ductal carcinoma. Compared with DCIS, microinvasive ductal carcinoma showed more suspicious imaging characteristics. For the non-mass lesions, clustered ring enhancement was also a characteristic finding of microinvasion on MRI.

The role of MRI and clinicopathologic features in predicting the invasive component of biopsy-confirmed ductal carcinoma in situ

“…In terms of the MRI morphologic features of diagnosed DCIS, an irregular shape, not-circumscribed margins, rim-enhancing masses, and clumped or clustered ring-enhancing NMEs were significantly associated with a histologic upgrade in our study. This is consistent with previous reports indicating that suspicious morphologic imaging features indicate a likelihood of malignancy [ 16 , 20 , 30 – 34 ]. Hahn et al reported that a spiculated mass, segmental distribution, clustered ring enhancement of an NME, and enhancement kinetics showing a strong initial enhancement with subsequent washout were significantly more frequent in mIDC than in DCIS [ 16 ].…”

“…This is consistent with previous reports indicating that suspicious morphologic imaging features indicate a likelihood of malignancy [ 16 , 20 , 30 – 34 ]. Hahn et al reported that a spiculated mass, segmental distribution, clustered ring enhancement of an NME, and enhancement kinetics showing a strong initial enhancement with subsequent washout were significantly more frequent in mIDC than in DCIS [ 16 ]. Tozaki et al demonstrated that clustered ring enhancements had the highest positive predictive value for malignancy in NME lesions [ 32 , 33 ].…”

“…In our current analyses, we found no significant differences in NME distribution between the three groups; however, the invasive groups showed higher percentages of segmental distribution than the pure DCIS group. This finding is consistent with that of previous studies [16,29], and although this difference did not reach statistical significance in our analyses, segmental distribution of NMEs might be helpful in the diagnosis of invasive disease.…”

“…DCIS typically manifests as calcifications visible on mammography [12]; however, ultrasound (US) and magnetic resonance imaging (MRI) play an important role in detecting and assessing the extent of these lesions [13]. Several prior studies have described the US [14,15] and MRI features [6,[16][17][18][19][20] that can predict the invasive component of a biopsy-proven DCIS. However, there have been few reports that have compared MRI findings between pure DCIS and mIDC cases [21].…”

Simple magnetic resonance imaging criteria can differentiate ductal carcinomas in situ from invasive carcinomas

“…These lesions are commonly associated to NME pattern and frequently display less suspicious kinetic enhancement characteristics 17,18 , which is in agreement to our own results. When microinvasion or frank invasion ensues, the imaging findings tend to become more typically suspicious 19 . Therefore, masses are more common among invasive neoplasms, especially when portraying spiculated margin, strong initial enhancement followed by washout (Type 3 curve), or other suspicious descriptors, as we have shown in concordance to others 20 .…”