Gaiane M. Rauch MD, PhD, Presenter: Nothing to Disclose

Henry M. Kuerer MD, Abstract Co-Author: Nothing to Disclose

Marion Elizabeth Scoggins MD, Abstract Co-Author: Nothing to Disclose

Ana Paula Benveniste MD, Abstract Co-Author: Nothing to Disclose

Patricia S. Fox MS, Abstract Co-Author: Nothing to Disclose

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

Young Mi Park, Abstract Co-Author: Nothing to Disclose

Sara Lari, Abstract Co-Author: Nothing to Disclose

Brian Hobbs PhD, Abstract Co-Author: Nothing to Disclose

Savitri Krishnamurthy MD, Abstract Co-Author: Nothing to Disclose

The clinico-pathological, mammogram (M), and ultrasound (US) findings in patients with pure ductal carcinoma in situ (DCIS) were assessed by estrogen receptor (ER) expression.

A retrospective single institution database search was performed from January 1, 1996 to July 31, 2009 of patients with pure DCIS and known ER status who had imaging (M or US) available for review. All M and US images were reviewed according to the ACR BIRADS® lexicon. Clinical, pathologic, and imaging characteristics were analyzed with respect to ER status. T-test, Chi-square, and Fisher’s exact tests were used for statistical analysis.

There were 1219 patients with pure DCIS and known ER status; 32 were excluded due to incomplete data leaving 1187 patients for final analysis. M was performed in all 1187 (100%) patients; US in 519 (44%) patients. There were 972 (82%) patients with ER+ and 215 (18%) with ER- disease. The mean age at diagnosis was 56 years (SD 11). ER- DCIS was more likely to be high grade (93% vs 44%, p<0.001), comedo type (64% vs 29%, p<0.0001), with necrosis (65% vs 38%, p<0.0001), multifocal and multicentric (both 23% vs 15%, p<0.05). By US, ER- DCIS was more likely to be visible (61% vs 46%, p<0.01), larger (2.3 vs 1.6 cm, p<0.01), and show posterior shadowing (53% vs 28%, p<0.05). By M, coarse heterogeneous and linear branching calcifications were more frequently associated with ER- tumors (34% vs 27%, p<0.05). Mastectomy was more frequently performed for ER- DCIS (47% vs 37%, p<0.01). At histopathology, solid pattern was prevalent in ER- tumors (78% vs 61%, p<0.0001) and cribriform pattern more common in ER+ tumors (65% vs 40%, p<0.0001).

ER- DCIS is more likely to be high grade tumor with comedo necrosis, more likely associated with coarse heterogeneous and linear branching calcifications on M, and more likely to be a mass with shadowing and larger in size when detected on US. ER- DCIS is more likely multifocal or multicentric than ER+ tumors, and is more frequently associated with mastectomy.

To our knowledge, this is the first clinical study describing clinicopathologic and imaging differences associated with biologic subtypes of DCIS that may impact diagnosis, staging, and therapy.

Rauch, G, Kuerer, H, Scoggins, M, Benveniste, A, Fox, P, Yang, W, Park, Y, Lari, S, Hobbs, B, Krishnamurthy, S, Biologic Subtype and Imaging Correlates of 1,187 Patients with Pure Ductal Carcinoma in Situ of the Breast.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12024382.html