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

• Published in: The breast journal Vol. 19; no. 6; p. 650
• Main Authors: Wisner, Dorota Jakubowski, Hwang, E Shelley, Chang, C Belinda, Tso, Hilda H, Joe, Bonnie N, Lessing, Juan N, Lu, Ying, Hylton, Nola M
• Format: Journal Article
• Language: English
• Published: United States 01-11-2013
• Subjects: Adult; Aged; Biopsy; Breast Neoplasms - pathology; Carcinoma, Intraductal, Noninfiltrating - pathology; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging - methods; Middle Aged; Neoplasm Invasiveness; Retrospective Studies; ductal carcinoma in situ; invasive ductal carcinoma; magnetic resonance imaging; invasive lobular carcinoma; carcinoma; kinetics; signal enhancement ratio; breast
• ISSN: 1524-4741
• DOI: 10.1111/tbj.12201

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.