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Updated: Oct 26, 2025
Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging
Published on: December 15, 2014
Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a
Shinn-Huey S Chou1, Justin Romanoff1, Constance D Lehman1
1From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.).
Abstract:
Background There are limited data from clinical trials describing preoperative MRI features and performance in the evaluation of mammographically detected ductal carcinoma in situ (DCIS). Purpose To report qualitative MRI features of DCIS, MRI performance in the identification of additional disease, and associations of imaging features with pathologic, genomic, and surgical outcomes from the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E4112 trial. Materials and Methods Secondary analyses of a multicenter prospective clinical trial from the ECOG-ACRIN Cancer Research Group included women with DCIS diagnosed with conventional imaging techniques (mammography and US), confirmed via core-needle biopsy (CNB), and enrolled between March 2015 and April 2016 who were candidates for wide local excision (WLE) based on conventional imaging and clinical examination results. DCIS MRI features and pathologic features from CNB and excision were recorded. Each woman without invasive upgrade of the index DCIS at WLE received a 12-gene DCIS score. MRI performance metrics were calculated. Associations of imaging features with invasive upgrade, dichotomized DCIS score (<39 vs ≥39), and single WLE success were estimated in uni- and multivariable analyses. Results Among 339 women (median age, 60 years; interquartile range, 51-66 years), most DCIS cases showed nonmass enhancement (NME) (195 of 339 [58%]) on MRI scans with larger median size than on mammograms (19 mm vs 12 mm; P < .001). Positive predictive value of MRI-prompted CNBs was 32% (21 of 66) (95% CI: 22, 44), yielding an additional cancer detection rate of 6.2% (21 of 339) (95% CI: 4.1, 9.3). MRI false-positive rate was 14.2% (45 of 318) (95% CI: 10.7, 18.4). No imaging features were associated with invasive upgrade or DCIS score (P = .05 to P = .95). Smaller size and focal NME distribution at MRI were linked to single WLE success (P < .001). Conclusion Preoperative MRI depicted ductal carcinoma in situ (DCIS) diagnosed with conventional imaging most commonly as nonmass enhancement, with larger median span than mammography, and additional cancer detection rate of 6.2%. MRI features of this subset of DCIS did not enable prediction of pathologic or genomic outcomes. Clinical trial registration no. NCT02352883 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Kuhl in this issue. An earlier incorrect version of this article appeared online. This article was corrected on August 4, 2021.
