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Published on: December 15, 2014
Pure ductal carcinoma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and
Sanaz A Jansen1, Gillian M Newstead, Hiroyuki Abe
1Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA.
Purpose:
To retrospectively compare the kinetic and morphologic characteristics of pure ductal carcinoma in situ (DCIS) lesions depicted on dynamic contrast material-enhanced magnetic resonance (MR) images with the nuclear grade and conventional mammographic appearance of these lesions.
Materials And Methods:
This HIPAA-compliant retrospective study was institutional review board approved, and informed patient consent was waived. Seventy-eight patients with 79 histologically proved pure DCIS lesions were selected. There were 17 low-nuclear-grade, 26 intermediate-nuclear-grade, 30 high-nuclear-grade, and six unclassified lesions. Sixty-five lesions were classified as fine pleomorphic, fine linear, or fine linear-branching calcifications (n = 31); amorphous or indistinct calcifications (n = 18); noncalcified mass (n = 10); or occult (n = 6) at conventional (x-ray) mammography. One experienced radiologist analyzed lesion morphology and kinetic curve shape according to the Breast Imaging Reporting and Data System lexicon. Initial enhancement percentage, time to peak enhancement (T(peak)), and signal enhancement ratio (a measure of washout) were calculated for each lesion.
Results:
Of the 79 pure DCIS lesions, 20 (25%) exhibited enhancement plateau curves and 35 (44%) exhibited washout curves. The lesions with a masslike appearance on mammograms exhibited more suspicious kinetic characteristics (mean T(peak) approximately 2 minutes) than did the lesions with amorphous or indistinct calcifications (mean T(peak) = 4.4 minutes). There was no significant difference in enhancement kinetic properties across the nuclear grades. Lesion morphology was predominantly nonmass, with clumped or heterogeneous enhancement in a segmental or linear distribution.
Conclusion:
The pure DCIS lesions exhibited washout, plateau, and persistent enhancement curves. Enhancement kinetic characteristics varied with mammographic appearance but not with nuclear grade.
Supplemental Material:
http://radiology.rsnajnls.org/cgi/content/full/245/3/684/DC1.
Insights
Dynamic contrast-enhanced MRI reveals that ductal carcinoma in situ (DCIS) enhancement patterns vary with mammographic appearance, not nuclear grade. This aids in understanding DCIS lesion characteristics.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Dynamic contrast-enhanced magnetic resonance (MR) imaging is a key tool for characterizing breast lesions.
- Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer with variable imaging features.
- Understanding the relationship between imaging characteristics and histopathology is crucial for accurate diagnosis and management.
Purpose of the Study:
- To compare kinetic and morphologic features of pure DCIS on dynamic contrast-enhanced MR imaging.
- To correlate these MR imaging features with nuclear grade and conventional mammographic appearance.
- To enhance the diagnostic accuracy of MR imaging in identifying DCIS.
Main Methods:
- Retrospective analysis of 79 histologically confirmed pure DCIS lesions in 78 patients.
- Evaluation of lesion morphology and kinetic curve shapes using the Breast Imaging Reporting and Data System lexicon.
- Calculation of initial enhancement percentage, time to peak enhancement (T(peak)), and signal enhancement ratio.
Main Results:
- 25% of DCIS lesions showed plateau enhancement curves, and 44% showed washout curves.
- Masslike lesions on mammography had more suspicious kinetic characteristics (mean T(peak) ~2 min) than calcified lesions (mean T(peak) = 4.4 min).
- No significant difference in enhancement kinetics was found across different nuclear grades.
Conclusions:
- Pure DCIS lesions demonstrate diverse enhancement patterns including washout, plateau, and persistent curves.
- Enhancement kinetic characteristics are associated with mammographic appearance.
- Nuclear grade does not significantly influence the enhancement kinetic properties of pure DCIS.
