title: What is the sensitivity of mammography and dynamic MR imaging for DCIS if the whole-breast histopathology is used as a reference standard?
abstract: OBJECTIVE
  Our purpose was to compare mammography and dynamic contrast-enhanced magnetic resonance imaging (MRI) in the detection of ductal carcinoma in situ (DCIS).
  
  
  METHODS
  Ninety patients (aged 58.6+/-16.1 years) who were candidates for unilateral (n=81) or bilateral (n=9) mastectomy underwent mammography and dynamic contrast-enhanced breast MRI using a coronal three-dimensional gradient-echo sequence with slice thickness < or =3 mm before and after intravenous injection of gadoteridol (0.1 mmol/kg). Mammographic and MR images were evaluated by two offsite readers working in consensus. Pathological examination performed on 5-mm sections covering the whole breast was used as a reference standard.
  
  
  RESULTS
  Out of 99 breasts, pathology revealed 26 DCIS in 14 breasts of 14 patients, aged 52.0 +/- 9.6 years. Lesion diameter at pathology was <5 mm (n=4); > or =5 and <10 mm (n=7); > or =10 and <20 mm (n=3); > or =20 mm (n=2); not assessed (n=10). Sensitivity was 35% (9/26) for mammography and 38% (10/26) for MRI (not significant difference, McNemar test). Both mammography and MRI provided a true positive result in seven cases (four of them measured at pathology, with a diameter of 20.0+/-12.9 mm; median 20 mm) and a false negative result in 14 cases (10 of them measured at pathology, with a diameter of 4.2+/-1.9 mm; median 4.6 mm) (p=0.024, Mann-Whitney U test). Only 46% (12/26) of DCIS were detected at mammography and/or MRI; the remaining 54% (14/26) were diagnosed only at pathological examination.
  
  
  CONCLUSIONS
  When the whole breast is used as the histopathological reference standard, both mammography and MRI show low sensitivity for DCIS.
authors.affiliation: Department of Medical and Surgical Sciences, University of Milan School of Medicine, Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, Italy. francesco.sardanelli@unimi.it
authors.forename: F
authors.initials: F
authors.lastname: Sardanelli
authors.forename: L
authors.initials: L
authors.lastname: Bacigalupo
authors.forename: L
authors.initials: L
authors.lastname: Carbonaro
authors.forename: A
authors.initials: A
authors.lastname: Esseridou
authors.forename: G M
authors.initials: GM
authors.lastname: Giuseppetti
authors.forename: P
authors.initials: P
authors.lastname: Panizza
authors.forename: V
authors.initials: V
authors.lastname: Lattanzio
authors.forename: A
authors.initials: A
authors.lastname: Del Maschio
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium