Differentiation of ductal carcinoma in situ versus fibrocystic changes by magnetic resonance imaging: are there pathognomonic imaging features?
Background In breast magnetic resonance imaging (MRI), the diagnosis of ductal carcinoma in situ (DCIS) remains controversial; the most challenging cause of false-positive DCIS diagnosis is fibrocystic changes (FC). Purpose To search for typical and pathognomonic patterns of DCIS and FC using a standard clinical MRI protocol. Material and Methods Consecutive patients scheduled for breast MRI (standardized protocols @ 1.5T: dynamic-T1-GRE before/after Gd-DTPA [0.1 mmol/kg body weight (BW)]; T1-TSE), with subsequent pathological sampling, were investigated. Sixteen MRI descriptors were prospectively assessed by two experienced radiologists in consensus (blinded to pathology) and explored in patients with DCIS (n = 77) or FC (n = 219). Univariate and multivariate statistics were performed to identify the accuracy of descriptors (alone, combined). Furthermore, pathognomonic descriptor-combinations with an accuracy of 100% were explored (χ2statistics; decision trees). Results Six breast MRI descriptors significantly differentiated DCIS from FC ( Pcorrected< 0.05; odds ratio < 7.9). Pathognomonic imaging features were present in 33.8% (n = 100) of all cases allowing the identification of 42.9% of FC (n = 94). Conclusion Pathognomonic patterns of DCIS and FC were frequently observed in a standard clinical MRI protocol. Such imaging patterns could decrease the false-positive rate of breast MRI and hence might help to decrease the number of unnecessary biopsies in this clinically challenging subgroup.
1 Department of Radiology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.
Matthias
M
Dietzel
2 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany.
Clemens G
CG
Kaiser
1 Department of Radiology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.
Evelyn
E
Wenkel
3 Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.
Paola
P
Clauser
1 Department of Radiology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.
Michael
M
Uder
1 Department of Radiology, University Hospital Erlangen-Nürnberg, Erlangen, Germany.
Rüdiger
R
Schulz-Wendtland
3 Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.
Pascal At
PA
Baltzer
D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005348:Fibrocystic Breast Disease / Q000000981:diagnostic imaging*; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011446:Prospective Studies
D003287:Contrast Media; D019786:Gadolinium DTPA
Magnetic resonance imaging; breast cancer; diagnostic accuracy; ductal carcinoma in situ (DCIS); fibrocystic changes