Mee Young Nam MD, Presenter: Nothing to Disclose

Eun Young Ko MD, PhD, Abstract Co-Author: Nothing to Disclose

Boo-Kyung Han MD, PhD, Abstract Co-Author: Nothing to Disclose

Jung Hee Shin MD, Abstract Co-Author: Nothing to Disclose

Seok Seon Kang MD, Abstract Co-Author: Nothing to Disclose

Soo Yeon Hahn MD, Abstract Co-Author: Nothing to Disclose

Ji-young Hwang MD, Abstract Co-Author: Nothing to Disclose

The aim of this study was to get the specific clues predicting the invasive lesion on preoperative breast MRI in percutaneous biopsy-proven Ductal Carcinoma In Situ (DCIS) patients.

We analyzed MRI findings of 80 percutaneous biopsy-proven DCIS in 76 patients. Two radiologists retrospectively reviewed preoperative breast MRI without information of final pathologic results. We analyzed MR findings by the criteria of enhancement type (mass / non-mass), kinetics (presence of early enhancement and washout), and extent of the lesions. In the non-mass lesions, we divided them by diffuse/regional, segmental/ductal, and focal/solitary type. In the extent of lesions, we measured long diameter and analyzed the cutoff value predicting invasive lesion using ROC.

Four cases showed no residual lesion in pathologic result after surgery. Out of the 76 lesions, 27 lesions were confirmed as invasive ductal carcinoma (IDC) and 49 lesions were confirmed as DCIS. Enhancement type was similar in both IDC and DCIS. In IDC, 25/27 (93%) lesions showed early enhancement and 15/27 (56%) lesions showed washout pattern, while 25/49 (50%) lesion showed early enhancement and 12/49 (24%) showed washout pattern in DCIS. Presence of washout pattern was significantly higher in IDC (p= .017). The extent of invasive carcinoma was significantly larger than that of pure DCIS (5.01 ± 2.2cm vs 2.82 ± 1.9cm). The cutoff value of extent using ROC analysis was 4cm. When we applicated the standard of early enhancement and extent more than 4cm for predicting invasive lesion, the sensitivity, specificity, PPV and NPV were 70.4%, 79.6%, 65.5%, and 83.0%, retrospectively.

IDC showed significantly larger extent and more frequent washout pattern compared with DCIS on MRI. Combined criteria of the extent of lesion and early enhancement could be useful parameter predicting invasiveness in the biopsy-proven DCIS.

In the biopsy–proven DCIS patients, larger extent of lesion and early enhancement pattern on MRI could be useful predictive clues of invasiveness. By adding washout, the value can be increased more.

Nam, M, Ko, E, Han, B, Shin, J, Kang, S, Hahn, S, Hwang, J, Findings Predict Invasive Lesion on Breast MRI in Patients Who Were Diagnosed with Ductal Carcinoma in Situ by Preoperative Biopsies.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015984.html