title: The clinical significance of breast MRI in the management of ductal carcinoma in situ diagnosed on needle biopsy.
abstract: OBJECTIVE
  To identify the factors associated with invasive disease in ductal carcinoma in situ diagnosed on needle biopsy by analyzing breast magnetic resonance imaging findings with the histopathological factors of biopsy specimens.
  
  
  METHODS
  This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. Seventy-five ductal carcinoma in situ patients diagnosed by needle biopsy who underwent preoperative magnetic resonance imaging were retrospectively reviewed. The magnetic resonance imaging and histopathological variables were assessed between pure ductal carcinoma in situ and invasive breast cancer diagnosed on surgical specimens. Multivariable analyses were performed to determine the independent factors for invasion using a logistic-regression model.
  
  
  RESULTS
  The median age of patients was 55 (34-76) years. On dynamic magnetic resonance imaging, 60 cases out of 75 (80%) were classified as non-mass-like enhancement type and 15/75 (20%) were Mass type. In non-mass-like enhancement, 11/60 (18%) were ultimately diagnosed as invasive breast cancer. Lesion size (P = 0.027), signal intensity ratios (calculated as the signal intensity of detected lesions divided by the signal intensity of surrounding normal breast tissue; P = 0.032) on magnetic resonance imaging and the number of biopsy-cores containing cancer nests (P = 0.012) were each independently associated with invasion. Furthermore, each signal intensity ratio of invasive and non-invasive components of invasive breast cancer represented a value significantly higher than that of 49 pure ductal carcinoma in situ classified as non-mass-like enhancement (P = 0.001 and P = 0.034, respectively). Conversely, there were no significant magnetic resonance imaging findings to distinguish seven invasive breast cancer from among Mass type.
  
  
  CONCLUSIONS
  Needle-biopsy-proven ductal carcinoma in situ cases with non-mass-like enhancement type might be sufficiently managed using breast magnetic resonance imaging features such as enhanced lesion size and signal intensity, incorporating the number of cancer-cores at needle biopsy specimen in the clinical setting.
authors.affiliation: Department of Surgery and Breast Surgery, Nihonkai General Hospital, 30 Akiho-cho, Sakata 998-8501, Japan. atihsayim8m8@med.tohoku.ac.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyashita
authors.forename: Goro
authors.initials: G
authors.lastname: Amano
authors.forename: Takanori
authors.initials: T
authors.lastname: Ishida
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamaki
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Uchimura
authors.forename: Tomo
authors.initials: T
authors.lastname: Ono
authors.forename: Mioko
authors.initials: M
authors.lastname: Yajima
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kuriya
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies
keywords: DCIS; MRI; breast cancer; needle biopsy; occult invasion