Yien Sien Lee MBBS, Presenter: Nothing to Disclose

Jean Kunjummen DO, Abstract Co-Author: Nothing to Disclose

Basak Erguvan Dogan MD, Abstract Co-Author: Nothing to Disclose

Lei Huo MD, Abstract Co-Author: Nothing to Disclose

Erika Resetkova MD, Abstract Co-Author: Nothing to Disclose

Kelly K. Hunt MD, Abstract Co-Author: Nothing to Disclose

Wei Tse Yang MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

Our primary goal was to identify distinct imaging features of micropapillary DCIS. Our secondary goal was to identify the imaging modality that most accurately demonstrates the disease extent.

Women identified as having pure DCIS with predominant micropapillary subtype from the pathology database in a single institution between 2004 and April 2008 were retrospectively analyzed. Two dedicated breast pathologists reviewed the histopathology specimens and confirmed that micropapillary DCIS comprised 80% or more of the DCIS volume, and determined the pathologic size for all tumors. Patient age and clinical presentation were derived from the medical records. The pre-operative imaging findings at mammography, sonography, and where available, MRI, were documented using the ACR BI-RADS lexicon. Lesion size, location, extent, skin or nipple involvement, and multifocal/multicentric disease were recorded, and compared with final histology.

There were a total of 43 women with 43 tumors. The mean age was 55 years, (range, 33-82 years). The mean tumor size was 4.7cm, range, 0.5-13cm. Mammography was performed in all 43 tumors, sonography in 37/43 (86%), and MRI in 5/43 (12%). Mammography demonstrated an abnormality in all 43 tumors. The most common finding at mammography was calcifications, noted in 37/43 (86%) tumors. Calcifications were pleomorphic in a segmental or regional distribution in 15/37 (41%) tumors, and amorphous in 11/37 (30%). Sonography did not show an abnormality in 18/37 (49%) tumors, revealed a mass in 7/37 (19%) tumors, architectural distortion in 6/37 (16%), and dilated ducts in 6/37 (16%). On MRI, micropapillary DCIS appeared as segmental or regional non-mass-like enhancement with heterogeneous internal enhancement in all 5 tumors. Mammography size was concordant with pathology in 19/41(46%), ultrasound size concordant with pathology in 6/37 (16%), and MRI size concordant with pathology in 5/5 (100%). Mammography underestimated disease extent in 15/41 (37%) cases.

Micropapillary DCIS most commonly presents as pleomorphic segmental calcifications while sonography is often negative, even in the presence of extensive disease. MRI showed an abnormality and accurately delineated disease extent in all tumors.

MRI may be a superior adjunctive imaging modality to evaluate disease extent for surgical planning, and requires further study in larger studies.

Lee, Y, Kunjummen, J, Dogan, B, Huo, L, Resetkova, E, Hunt, K, Yang, W, et al, 0, Imaging Features of Micropapillary DCIS.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8011370.html