Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ: value in the diagnosis of residual disease, occult invasion, and multicentricity.
BACKGROUND
Although magnetic resonance imaging (MRI) has been shown to be a sensitive imaging tool for invasive breast cancers, its utility in ductal carcinoma-in-situ (DCIS) of the breast remains controversial. We studied the performance of MRI in patients with known DCIS for assessment of residual disease, occult invasion, and multicentricity to determine the clinical role of MRI in this setting.


METHODS
Fifty-one patients with biopsy-proven DCIS underwent contrast-enhanced MRI before surgical treatment. Pre-, early post-, and late postcontrast three-dimensional gradient echo images were obtained and MRI findings were correlated with histopathology. When possible, the performance of MRI and mammography was compared.


RESULTS
The accuracy of MRI was 88% in predicting residual disease, 82% in predicting invasive disease, and 90% in predicting multicentricity. The performance of MRI was equivalent in the core biopsy group when compared with the surgical biopsy group. For occult invasion only, MRI and mammography were equivalent. However, overall, MRI was more sensitive and had a higher negative predictive value than mammography.


CONCLUSIONS
MRI of DCIS can serve as a useful adjunct to mammography by providing a more accurate assessment of the extent of residual or multicentric disease. The performance of MRI is not significantly affected by antecedent surgical excision. MRI may be particularly valuable if preoperatively negative.
Department of Surgery, University of California-San Francisco, San Francisco, California 94115, USA. shelley.hwang@ucsfmedctr.org
E Shelley
ES
Hwang
Karen
K
Kinkel
Laura J
LJ
Esserman
Ying
Y
Lu
Noel
N
Weidner
Nola M
NM
Hylton
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies