Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ

The purpose of this study was to describe the features of symptomatic ductal carcinoma in situ (DCIS) of the breast shown on high-resolution sonography and to correlate them with findings from mammography and histopathology to evaluate the prognostic ability of sonographic findings.

We retrospectively reviewed mammographic and sonographic images of 60 DCIS lesions from 55 symptomatic women. Images were reviewed by a radiologist who knew that the patients had DCIS but had no other information regarding pathology. Lesions were evaluated pathologically and classified using the Van Nuys classification system. Statistical comparisons were made using Fisher's exact test.

Of the 60 lesions, 33 were classified as Van Nuys group 1, 19 as Van Nuys group 2, and eight as Van Nuys group 3. Six (10%) of the 60 lesions were not visible on sonography, and 12 lesions (20%) were not visible on mammography. Sonography revealed a mass in 43 cases (72%), ductal changes in 14 cases (23%), and architectural distortion in four cases (7%). Eight lesions had more than one of these features. A sonographically visualized, irregularly shaped mass with indistinct or angular margins and no posterior acoustic shadowing or enhancement was associated with a high Van Nuys classification (p < 0.05). Microcalcifications were visible on sonography in 13 (22%) of the 60 lesions or on mammography in 25 lesions (42%). Both findings were associated with a high Van Nuys classification (p < 0.05).

Although sonography can reveal microcalcifications within masses, it is unreliable in depicting and characterizing the morphology and extent of microcalcifications, particularly when they are in isolation. Therefore, sonography should not be used to replace mammography but instead as an adjunctive tool to increase the sensitivity of mammography in breast diagnosis.