1. Predict “invasive component” within ductal carcinoma in situ – the breast MRI features and clinicopathologic factors ?
Hung-Wen Lai, MD, PhD1,4, Dar-Ren Chen, MD1, Shou-Tung Chen, MD1,
Chih-Wei Lee, MD2, Hwa-Koon Wu, MD2, Chih-Jung Chen, MD, PhD3, Shou-Jen Kuo, MD2
1Comprehensive Breast Cancer Center, 2Departemnt of Radiology, 3Department of surgical pathology,
Changhua Christian Hospital, Changhua, Taiwan
4School of Medicine, National Yang Ming University, Taipei, Taiwan A B C D
【Purpose】
Ductal carcinoma in situ (DCIS) is a pre-invasive breast lesion. Around 10-52% of patients diagnosed as DCIS by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) were upgraded to invasive carcinoma following surgical excision. The goal of current study is to evaluate the role of clinicopathologic factors and breast magnetic resonance image (MRI) features for prediction of DCIS with invasive component before operation.
【Material and Methods】
Patients diagnosed as DCIS by CNB or VACB with pre-operative breast MRI, and received breast cancer operation at Changhua Christian Hospital were included. The clinicopathologic and breast MRI factors of patients with postoperative pathology with invasive component were compared with patients with postoperative pathology remained DCIS.
【Results】
A total of 128 pre-operative DCIS patients comprise the current study, 73 (57.0%) of them the post-operative pathology remained DCIS, and 55 (43.0%) upgraded to DCIS with invasive component. The MRI mass like lesion (P=0.025), nipple invasion in MRI (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), clumped or homogenous enhancement pattern (P=0.010), and presence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were associated with higher risk to upgrade to have invasive carcinoma from DCIS in the post-operative surgical specimen.
【Conclusions】
MRI findings such as mass like lesion, suspect of nipple invasion, larger tumor volume, larger maximum measurable ADC area, clumped or homogenous enhancement pattern, and presence of HER-2 overexpression were associated with higher risk to upgrade to invasive carcinoma from DCIS.
Figure 1. A 53-year-old female who was diagnosed ductal carcinoma in situ by core needle biopsy underwent gadobenic acid-enhanced MRI study. One irregular, clumped enhancing mass-like lesion in the upper outer quadrant of left breast was found. A. Maximum-intensity-projection subtraction images of post-contrast study. B. Fusion sagittal images. C. Kinetic curve showed initial rise enhancement pattern and type III washout pattern. D. ADC value measured ×10−3 mm2/s and ADC area 0.96cm2. After mastectomy, the pathology proved invasive component.