title: Features of occult invasion in biopsy-proven DCIS at breast MRI.
abstract: The purpose of this study is to determine if MRI BI-RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Retrospective search spanning 2000-2007 identified all core-biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship-trained in breast imaging categorized lesions according to ACR MRI BI-RADS lexicon and estimated likelihood of occult invasion. Semiquantitative signal enhancement ratio (SER) kinetic analysis was also performed. Results were compared with histopathology. 51 consecutive patients with primary core biopsy-proven DCIS and concurrent MRI were identified. Of these, 13 patients (25%) had invasion at excision. Invasion correlated significantly with presence of a mass for both readers (p = 0.012 and 0.001), rapid initial enhancement for Reader 1 (p = 0.001), and washout kinetics for Reader 2 (p = 0.012). Significant correlation between washout and invasion was confirmed by SER (p = 0.006) when threshold percent enhancement was sufficiently high (130%), corresponding to rapidly enhancing portions of the lesion. Radiologist perception of occult invasion was strongly correlated with true presence of invasion. These results provide evidence that certain BI-RADS MRI criteria, as well as radiologist perception, correlate with occult invasion after an initial core biopsy of DCIS.
authors.affiliation: Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California.
authors.forename: Dorota Jakubowski
authors.initials: DJ
authors.lastname: Wisner
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
authors.forename: C Belinda
authors.initials: CB
authors.lastname: Chang
authors.forename: Hilda H
authors.initials: HH
authors.lastname: Tso
authors.forename: Bonnie N
authors.initials: BN
authors.lastname: Joe
authors.forename: Juan N
authors.initials: JN
authors.lastname: Lessing
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Nola M
authors.initials: NM
authors.lastname: Hylton
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies
keywords: breast; carcinoma; ductal carcinoma in situ; invasive ductal carcinoma; invasive lobular carcinoma; kinetics; magnetic resonance imaging; signal enhancement ratio