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Updated: Feb 22, 2026

Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging
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Microcalcifications matter: Diagnostic and biological differences in DCIS.

Luca Nicosia1, Luciano Mariano1, Carmen Mallardi2

  • 1Division of Breast Radiology, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology, IRCCS, 20141, Via Ripamonti 435, Milano, Italy.

Cancer Treatment and Research Communications
|February 20, 2026
PubMed
Summary

Non-calcified ductal carcinoma in situ (DCIS) and larger lesions are linked to a higher risk of upstaging to invasive breast cancer. This finding emphasizes the importance of radiological presentation in assessing DCIS risk.

Keywords:
Active surveillanceBreast microcalcificationsDisease progressionDuctal carcinoma in situ

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Area of Science:

  • Oncology
  • Radiology
  • Pathology

Background:

  • Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer.
  • Microcalcifications are common in DCIS, but some cases lack them, complicating diagnosis.
  • Radiological presentation impacts diagnostic challenges and management strategies for DCIS.

Purpose of the Study:

  • To investigate the relationship between radiological presentation (calcified vs. non-calcified) and the risk of upstaging to invasive carcinoma.
  • To identify predictors of upstaging in DCIS, including calcification status and lesion size.

Main Methods:

  • Retrospective analysis of 196 patients with biopsy-proven DCIS.
  • Matching of 98 non-calcified DCIS cases with 98 calcified DCIS cases.
  • Investigation of associations between upstaging and calcification status, age, lesion size, and histologic grade.

Main Results:

  • Overall underestimation rate was 13.8%.
  • Non-calcified DCIS had a higher upstaging rate (19%) compared to calcified DCIS (8%).
  • Larger lesion size was associated with increased underestimation risk; age was not significant.

Conclusions:

  • Non-calcified DCIS is independently associated with upstaging to invasive carcinoma.
  • Larger lesion size is also independently associated with upstaging.
  • Radiological presentation is clinically relevant for DCIS risk stratification.