Features of occult invasion in biopsy-proven DCIS at breast MRI

Dorota Jakubowski Wisner, E. Shelley Hwang, C. Belinda Chang, Hilda H. Tso, Bonnie N. Joe, Juan N. Lessing, Ying Lu, Nola M. Hylton

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

The purpose of this study is to determine if MRI BI-RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Retrospective search spanning 2000-2007 identified all core-biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship-trained in breast imaging categorized lesions according to ACR MRI BI-RADS lexicon and estimated likelihood of occult invasion. Semiquantitative signal enhancement ratio (SER) kinetic analysis was also performed. Results were compared with histopathology. 51 consecutive patients with primary core biopsy-proven DCIS and concurrent MRI were identified. Of these, 13 patients (25%) had invasion at excision. Invasion correlated significantly with presence of a mass for both readers (p = 0.012 and 0.001), rapid initial enhancement for Reader 1 (p = 0.001), and washout kinetics for Reader 2 (p = 0.012). Significant correlation between washout and invasion was confirmed by SER (p = 0.006) when threshold percent enhancement was sufficiently high (130%), corresponding to rapidly enhancing portions of the lesion. Radiologist perception of occult invasion was strongly correlated with true presence of invasion. These results provide evidence that certain BI-RADS MRI criteria, as well as radiologist perception, correlate with occult invasion after an initial core biopsy of DCIS.

Original languageEnglish (US)
Pages (from-to)650-658
Number of pages9
JournalBreast Journal
Volume19
Issue number6
DOIs
StatePublished - Nov 2013
Externally publishedYes

Keywords

  • breast
  • carcinoma
  • ductal carcinoma in situ
  • invasive ductal carcinoma
  • invasive lobular carcinoma
  • kinetics
  • magnetic resonance imaging
  • signal enhancement ratio

ASJC Scopus subject areas

  • Internal Medicine
  • Surgery
  • Oncology

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