Related Experiment Video
Updated: Feb 26, 2026
Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging
Published on: December 15, 2014
Imaging Features of Patients Undergoing Active Surveillance for Ductal Carcinoma in Situ
Lars J Grimm1, Sujata V Ghate1, E Shelley Hwang2
1Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
Rationale And Objectives:
The aim of this study was to describe the imaging appearance of patients undergoing active surveillance for ductal carcinoma in situ (DCIS).
Materials And Methods:
We retrospectively identified 29 patients undergoing active surveillance for DCIS from 2009 to 2014. Twenty-two patients (group 1) refused surgery or were not surgical candidates. Seven patients (group 2) enrolled in a trial of letrozole and deferred surgical excision for 6-12 months. Pathology and imaging results at the initial biopsy and follow-up were recorded.
Results:
In group 1, the median follow-up was 2.7 years (range: 0.6-13.9 years). Fifteen patients (68%) remained stable. Seven patients (32%) underwent additional biopsies with invasive ductal carcinoma diagnosed in two patients after 3.9 and 3.6 years who developed increasing calcifications and new masses. In group 2, one patient (14%) was upstaged to microinvasive ductal carcinoma at surgery. Among the patients in both groups with calcifications (n = 26), there was no progression to invasive disease among those with stable (50%, 13/26) or decreased (19%, 5/26) calcifications.
Conclusions:
Among a DCIS active surveillance cohort, invasive disease progression presented as increasing calcifications and a new mass following more than 3.5 years of stable imaging. In contrast, there was no progression to invasive disease among cases of DCIS with stable or decreasing calcifications. Close imaging is a key follow-up component in active surveillance.
Insights
Active surveillance for ductal carcinoma in situ (DCIS) shows invasive disease progression can appear as new masses and increasing calcifications. Stable or decreasing calcifications in DCIS patients indicate no progression to invasive disease.
Area of Science:
- Oncology
- Radiology
- Pathology
Background:
- Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer.
- Active surveillance is an alternative management strategy for DCIS.
- Monitoring imaging changes is crucial for detecting disease progression.
Purpose of the Study:
- To describe the imaging characteristics of patients with DCIS under active surveillance.
- To identify imaging features associated with invasive disease progression in DCIS.
- To evaluate the role of imaging in monitoring DCIS during active surveillance.
Main Methods:
- Retrospective identification of 29 DCIS patients on active surveillance (2009-2014).
- Two groups: 22 refusing/ineligible for surgery, 7 on letrozole deferring surgery.
- Recorded pathology and imaging at biopsy and follow-up.
Main Results:
- In 29 DCIS patients, 15 (68%) remained stable during surveillance.
- Two patients developed invasive ductal carcinoma after 3.6-3.9 years, presenting with increasing calcifications and new masses.
- No invasive progression observed in patients with stable or decreasing calcifications (n=26).
Conclusions:
- Invasive progression in DCIS active surveillance may manifest as new masses and increasing calcifications after over 3.5 years.
- Stable or decreasing calcifications correlate with no invasive disease progression.
- Regular imaging surveillance is essential for managing DCIS.
