title: Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components.
abstract: OBJECTIVE
  Ductal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery.
  
  
  METHODS
  Patients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components.
  
  
  RESULTS
  Of the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens.
  
  
  CONCLUSIONS
  Invasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.
authors.affiliation: Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hwa-Koon
authors.initials: HK
authors.lastname: Wu
authors.affiliation: Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address: 143809@cch.org.tw.
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Lai
authors.affiliation: Department of Diagnostic Radiology, Lu-Kang Christian Hospital, Changhua, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Pei
authors.initials: WP
authors.lastname: Wu
authors.affiliation: Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shou-Tung
authors.initials: ST
authors.lastname: Chen
authors.affiliation: Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Dar-Ren
authors.initials: DR
authors.lastname: Chen
authors.affiliation: Department of surgical pathology, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shou-Jen
authors.initials: SJ
authors.lastname: Kuo
mesh_terms: D000328:Adult; D062005:Biopsy, Large-Core Needle / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005544:Forecasting; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009558:Nipples / Q000473:pathology; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D047368:Tumor Burden; D014618:Vacuum
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Breast magnetic resonance imaging (MRI); Ductal carcinoma in situ; Ductal carcinoma in situ with invasive components; Invasive breast cancer