In Vivo Assessment of Ductal Carcinoma in Situ Grade: A Model Incorporating Dynamic Contrast-enhanced and Diffusion-weighted Breast MR Imaging Parameters

Abstract

Purpose:To develop a model incorporating dynamic contrast material-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging features to differentiate high-nuclear-grade (HNG) from non-HNG ductal carcinoma in situ (DCIS) in vivo. Materials and Methods:This HIPAA-compliant study was approved by the institutional review board and requirement for informed consent was waived. A total of 55 pure DCIS lesions (19 HNG, 36 non-HNG) in 52 women who underwent breast MR imaging at 1.5 T with both DCE and DW imaging (b = 0 and 600 sec/mm 2 ) were retrospectively reviewed. The following lesion characteristics were recorded or measured: DCE morphology, DCE maximum lesion size, peak initial enhancement at 90 seconds, worst-curve delayed enhancement kinetics, apparent diffusion coefficient (ADC), contrast-to-noise ratio (CNR) at DW imaging with b values of 0 and 600 sec/mm 2 , and T2 signal effects (measured with CNR at b = 0 sec/mm 2 ). Univariate and stepwise multivariate logistic regression modeling was performed to identify MR imaging features that optimally discriminated HNG from non-HNG DCIS. Discriminative abilities of models were compared by using the area under the receiver operating characteristic curve (AUC). Results:HNG lesions exhibited larger mean maximum lesion size (P = .02) and lower mean CNR for images with b value of 600 sec/mm 2 (P = .004), allowing discrimination of HNG from non-HNG DCIS (AUC = 0.71 for maximum lesion size, AUC = 0.70 for CNR at b = 600 sec/mm 2 ). Differences in CNR for images with b value of 0 sec/mm 2 (P = .025) without corresponding differences in ADC values were observed between HNG and non-HNG lesions. Peak initial enhancement was the only kinetic variable to approach significance (P = .05). No differences in lesion morphology (P = .11) or worst-curve delayed enhancement kinetics (P = .97) were observed. A multivariate model combining CNR for images with b value of 600 sec/ mm 2 and maximum lesion size most significantly discriminated HNG from non-HNG (AUC = 0.81). Conclusion:The preliminary findings suggest that DCE and DW MR imaging features may aid in identifying patients with highrisk DCIS. Further study may yield a model combining MR characteristics with histopathologic data to facilitate lesion-specific targeted therapies.q RSNA, 2012

Evaluation of Apparent Diffusion Coefficient to Predict Grade, Microinvasion, and Invasion in Ductal Carcinoma In Situ of the Breast

“…DCIS is usually perceived as an area of nonmass enhancement on MRI (4,8,9,22). Most cases in our study (81.7 %) were nonmass enhancement lesions on MRI.…”

“…Since the early 1980s, the prevalence of DCIS has been rising as a result of the adoption of widespread mammographic screening for breast cancer and the advances in mammographic techniques, image processing, and interpretation of digital imaging (2)(3)(4)(5).…”

“…The use of diffusion-weighted imaging (DWI), which reflects the thermal diffusion of water molecules (Brownian motion), has been associated with higher specificity of breast MRI in the detection and characterization of invasive breast tumors (9)(10)(11) and DCIS (3)(4)(5). The most common measure evaluated using DWI is apparent diffusion coefficient (ADC), a measure of the rate of water movement.…”

“…A pilot study by Iima et al (3) showed that quantitative DWI could be used to identify patients with low-grade DCIS with high specificity; however, cases with microinvasion were excluded from their statistical analysis. Rahbar et al (4) showed that DCE and DWI features may help identify patients with high-grade DCIS, but their series did not investigate invasive and/or microinvasive disease.…”

Simple magnetic resonance imaging criteria can differentiate ductal carcinomas in situ from invasive carcinomas

“…When apparent diffusion coefficients (ADCs) are derived, a valuable quantitative parameter is obtained. There is evidence that these measurements are even correlated to biologic minutiae like the histologic grades of DCIS 13 . As a logical consequence, it could potentially discriminate pre-invasive from invasive carcinomas, leading to relevant therapeutic management implications 14 .…”