Ductal carcinoma in situ: MR imaging-histopathologic correlation.

Gilles, R.; Zafrani, B; Guinebretière, Jean Marc; Meunier, Martine; Lucidarme, Olivier; Tardivon, A.; Rochard, F.; Vanel, D.; Neuenschwander, S.; Arriagada, R.

doi:10.1148/radiology.196.2.7617854

Cited by 202 publications

(104 citation statements)

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“…Therefore, accurate evaluation of the extent of the intraductal spread is essential in making decisions regarding conservative therapy. According to previous studies [18,32,33], the sensitivity of MRI and sonography for the diagnosis of intraductal spread was high, although sonography had a tendency to underestimate intraductal spread when compared with MRI [18]. In our study, the presence of either calcifications alone or masses associated with calcifications on either mammography and sonography were significantly associated with positive EIC.…”

Section: Correlation Between Imaging and Prognostic Factors In Breastsupporting

confidence: 55%

Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer

Shin

Kim²,

Huh³

et al. 2011

BJR

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Objectives: The purpose of this study was to correlate sonographic and mammographic findings with prognostic factors in patients with node-negative invasive breast cancer. Methods: Sonographic and mammographic findings in 710 consecutive patients (age range 21-81 years; mean age 49 years) with 715 node-negative invasive breast cancers were retrospectively evaluated. Pathology reports relating to tumour size, histological grade, lymphovascular invasion (LVI), extensive intraductal component (EIC), oestrogen receptor (ER) status and HER-2/neu status were reviewed and correlated with the imaging findings. Statistical analysis was performed using logistic regression analysis and intraclass correlation coefficient (ICC). Results: On mammography, non-spiculated masses with calcifications were associated with all poor prognostic factors: high histological grade, positive LVI, EIC, HER-2/neu status and negative ER. Other lesions were associated with none of these poor prognostic factors. Hyperdense masses on mammography, the presence of mixed echogenicity, posterior enhancement, calcifications in-or-out of masses and diffusely increased vascularity on sonography were associated with high histological grade and negative ER. Associated calcifications on both mammograms and sonograms were correlated with EIC and HER-2/neu overexpression. The ICC value for the disease extent was 0.60 on mammography and 0.70 on sonography. Conclusion: Several sonographic and mammographic features can have a prognostic value in the subsequent treatment of patients with node-negative invasive breast cancer. Radiologists should pay more attention to masses that are associated with calcifications because on both mammography and sonography associated calcifications were predictors of positive EIC and HER-2/neu overexpression.

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Section: Correlation Between Imaging and Prognostic Factors In Breastsupporting

confidence: 55%

Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer

Shin

Kim²,

Huh³

et al. 2011

BJR

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“…DCIS is considered to be a nonobligate precursor of invasive cancer, and if treated has dramatically higher survival than invasive cancers. 18,19 Yet the sensitivity and specificity of DCEMRI for detection of DCIS needs improvement, 15,16,[20][21][22][23][24][25][26][27] particularly given recent American Cancer Society guidelines recommending breast MRI in the screening of women at high risk of developing breast cancer. 28 It is likely that mass-like and nonmass-like enhancement patterns reflect differences in the underlying physiology and vasculature of these lesions, which may in turn affect the kinetic characteristics.…”

Section: Introductionmentioning

confidence: 99%

DCEMRI of breast lesions: Is kinetic analysis equally effective for both mass and nonmass-like enhancement?

et al. 2008

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To perform a pilot study investigating whether the sensitivity and specificity of kinetic parameters can be improved by considering mass and nonmass breast lesions separately. The contrast media uptake and washout kinetics in benign and malignant breast lesions were analyzed using an empirical mathematical model ͑EMM͒, and model parameters were compared in lesions with masslike and nonmass-like enhancement characteristics. 34 benign and 78 malignant breast lesions were selected for review. Dynamic MR protocol: 1 pre and 5 postcontrast images acquired in the coronal plane using a 3D T1-weighted SPGR with 68 s timing resolution. An experienced radiologist classified the type of enhancement as mass, nonmass, or focus, according to the BI-RADS® lexicon. The kinetic curve obtained from a radiologist-drawn region within the lesion was analyzed quantitatively using a three parameter EMM. Several kinetic parameters were then derived from the EMM parameters: the initial slope ͑Slope ini ͒, curvature at the peak ͑ peak ͒, time to peak ͑T peak ͒, initial area under the curve at 30 s ͑iAUC 30 ͒, and the signal enhancement ratio ͑SER͒. The BI-RADS classification of the lesions yielded: 70 mass lesions, 38 nonmass, 4 focus. For mass lesions, the contrast uptake rate ͑␣͒, contrast washout rate ͑␤͒, iAUC 30 , SER, Slope ini , T peak and peak differed substantially between benign and malignant lesions, and after correcting for multiple tests of significance SER and T peak demonstrated significance ͑p Ͻ 0.007͒. For nonmass lesions, we did not find statistically significant differences in any of the parameters for benign vs. malignant lesions ͑p Ͼ 0.5͒. Kinetic parameters could distinguish benign and malignant mass lesions effectively, but were not quite as useful in discriminating benign from malignant nonmass lesions. If the results of this pilot study are validated in a larger trial, we expect that to maximize diagnostic utility, it will be better to classify lesion morphology as mass or nonmass-like enhancement prior to kinetic analysis.

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“…However, in a similar manner to invasive disease, DCIS induces angiogenesis and this can be detected in vivo by DCE-MRI ( Figure 5). In a study by Gilles et al (1995), dynamic MRI showed contrast enhancement in 34 out of 36 patients with DCIS. Other MR studies have reported variable accuracy for classification of microcalcification.…”

Section: Dcismentioning

confidence: 94%

Current applications and future direction of MR mammography

2003

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Compared with triple assessment for symptomatic and occult breast disease, magnetic resonance mammography (MRM) offers higher sensitivity for the detection of multifocal cancer, which is important in selecting patients appropriately for breast-conserving surgery. It is an ideal tool for the screening of patients with a high risk of breast cancer or where there is axillary disease or nipple discharge and conventional imaging has not revealed the primary focus. Techniques are now available to biopsy lesions only apparent on MRM. MRM can differentiate scar tissue from tumour; therefore, it is useful in patients in which there is possible recurrent disease. Clinical and X-ray mammographic assessment of response to neoadjuvant chemotherapy may be unreliable because of replacement of the tumour with scar tissue. MRM can identify responders and nonresponders with more accuracy. It is the modality of choice for the assessment of breast implants for rupture with accuracy higher than X-ray mammography and ultrasound. Advances in both spatial and temporal resolutions, the imaging sequences employed, pharmacokinetic modelling of contrast uptake, the use of dedicated and now phased-array breast coils, and gadolinium-based contrast agents have all played their part in the advancement of this imaging technique. Despite the limitations of patient compliance, scan-time and cost, this review describes how MRM has become a valuable tool in breast disease, especially in cases of diagnostic uncertainty. However, MRM must make the transition from research institutions into routine clinical practice.

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Ductal carcinoma in situ: MR imaging-histopathologic correlation.

Abstract: Contrast enhancement on dynamic MR images of DCIS may be due to the presence of tumor angiogenesis in the stroma.

Cited by 202 publications

References 0 publications

Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer

Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer

DCEMRI of breast lesions: Is kinetic analysis equally effective for both mass and nonmass-like enhancement?

Current applications and future direction of MR mammography

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