Preoperative MRI to Predict Upstaging of DCIS to Invasive Cancer at Surgery

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Ductal carcinoma in situ (DCIS) is frequently overtreated due to difficulties in predicting which cases will progress to invasive cancer.
• Core needle biopsy (CNB) diagnosis of DCIS lacks sufficient predictive power for upstaging at surgical excision.

Purpose of the Study:

• To investigate if quantitative magnetic resonance imaging (MRI) features can identify DCIS lesions diagnosed via CNB that are at risk of upstaging to invasive cancer.
• To assess the utility of quantitative MRI in guiding treatment decisions for DCIS.

Main Methods:

• Prospective observational clinical trial involving women with DCIS diagnosed by CNB.
• Quantitative analysis of dynamic contrast-enhanced (DCE) MRI features, including peak percent enhancement (PE) and Ktrans.
• Evaluation of associations between MRI features and upstaging using receiver operating characteristic (ROC) curve analysis.

Main Results:

• 15 out of 58 (26%) DCIS lesions were upstaged to invasive cancer at surgery.
• Higher peak percent enhancement (PE) on routine DCE-MRI was significantly associated with upstaging (AUC, 0.81).
• Quantitative MRI features outperformed advanced DCE-MRI metrics and other clinical/mammographic factors in predicting upstaging.

Conclusions:

• Quantitative MRI features show promise in identifying DCIS lesions likely to be upstaged to invasive cancer.
• These findings could support the selection of patients for active surveillance in de-escalation trials, potentially reducing overtreatment of DCIS.