title: Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS.
  
  
  METHODS
  A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI.
  
  
  RESULTS
  The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases.
  
  
  CONCLUSIONS
  DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.
authors.affiliation: Coordinator at the FEMME Breast Intervention Sector, Laboratório da Mulher. Assistant Physician of the Diagnostic Imaging Service, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gustavo Machado
authors.initials: GM
authors.lastname: Badan
authors.affiliation: PhD in Health Sciences from Santa Casa de São Paulo. Coordinator at the FEMME Breast Radiology Sector, Laboratório da Mulher. Assistant Physician of the Diagnostic Imaging Service, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Décio
authors.initials: D
authors.lastname: Roveda
authors.affiliation: Full Professor of the Faculdade de Ciências Médicas da Santa Casa de São Paulo. Head of the Gynecology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Sebastião
authors.initials: S
authors.lastname: Paito
authors.affiliation: Professor, PhD in Health Sciences from Santa Casa de São Paulo. Assistant Physician of the Diagnostic Imaging Service, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Eduardo de Faria Castro
authors.initials: Ede F
authors.lastname: Fleury
authors.affiliation: Specialist in Breast Imaging - MD, Member of the Breast Radiology Team at Santa Casa de São Paulo and the FEMME, Laboratório da Mulher, São Paulo, SP, Brazil.
authors.forename: Bianca
authors.initials: B
authors.lastname: Maragno
authors.affiliation: Coordinator of the FEMME Mammography Service, Laboratório da Mulher. Assistant Physician of the Diagnostic Imaging Service, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: Mario Sérgio Dantas do Amaral
authors.initials: MS
authors.lastname: Campos
authors.affiliation: Coordinator of the Breast Imaging Service, Department of Internal Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo. Mammographer at FEMME, Laboratório da Mulher, São Paulo, SP, Brazil.
authors.forename: Carlos Alberto Pecci
authors.initials: CA
authors.lastname: Ferreira
authors.affiliation: Specialist in General and Breast Radiology - Assistant Physician of the Diagnostic Imaging Service at Santa Casa de São Paulo and the FEMME, Laboratório da Mulher, São Paulo, SP, Brazil.
authors.forename: Felipe Augusto Trocoli
authors.initials: FA
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D015203:Reproducibility of Results