Christiane Katharina Kuhl MD, Presenter: Nothing to Disclose

Simone Schrading MD, Abstract Co-Author: Nothing to Disclose

Nuschin Morakkabati MD, Abstract Co-Author: Nothing to Disclose

Claudia C Leutner MD, Abstract Co-Author: Nothing to Disclose

Rita Schmutzler MD, Abstract Co-Author: Nothing to Disclose

Hans Schild, Abstract Co-Author: Nothing to Disclose

To investigate histologic and imaging features of DCIS in women with familial breast cancer (proven or suspected BRCA mutation carriers) undergoing multi-modality screening. To investigate sensitivity of the different imaging modalities.

A total 529 women at high genetic risk were systematically followed with yearly mammogram, yearly high frequency physician-performed ultrasound, and MRI, for a mean period of 3.1 years (yielding a total observation period of 1701 women years at-risk), plus a 2 year follow-up for validation of diagnoses. Images were read prospectively and independently by breast radiologists with a 10-year experience in reading mammography, ultrasound, or MR studies.

Intraductal cancer was identified in 19 patients with a mean age of 41 years: pure DCIS in 9 women (all clinically asymptomatic); DCIS coexisting with an invasive cancer (separate from or as extension) in another 10 patients. Median size of pure DCIS was 13 mm +/– 7 mm, range 8 – 28 mm; 3 had a low nuclear grade, 6 were high-grade. 8/9 pure DCIS and 10/10 DCIS associated with invasive cancer were diagnosed by screening: Suspicious mammographic calcifications were identified in 3 patients (all pure DCIS). The remaining 8 pure intraductal cancers and the 10 intraductal components of invasive cancers were mammographically occult. None of the total 19 manifestations were detected with US. In MRI, DCIS appeared as non-mass-related, segmental or linear enhancement in 8/9 pure DCIS and in 10/10 intraductal components. One low-grade pure DCIS was not identified on any imaging modality but identified incidentally at preventive mastectomy. For the diagnosis of pure DCIS, sensitivity of mammography, ultrasound, and MRI were 33%, 0%, and 89%, respectively.

In young women at high genetic risk, DCIS is only infrequently associated with calcifications. Therefore, the mammographic sensitivity for DCIS in this subset of patients is low. Ultrasound is of no additional value. MRI helps identify DCIS with a relatively high sensitivity, in particular regarding high-grade lesions.

Kuhl, C, Schrading, S, Morakkabati, N, Leutner, C, Schmutzler, R, Schild, H, Screening for Ductal Carcinoma in Situ (DCIS) in Women at High Genetic Risk for Breast Cancer (Proven or Suspected Carriers of a BRCA Mutation): Imaging Features and Diagnostic Sensitivity with Mammography, Ultrasound, and MRI.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4413003.html