Role of Breast MRI in the Evaluation and Detection of DCIS: Opportunities and Challenges

Abstract

Historically, breast magnetic resonance imaging (MRI) was not considered an effective modality in the evaluation of ductal carcinoma in situ (DCIS). Over the past decade this has changed, with studies demonstrating that MRI is the most sensitive imaging tool for detection of all grades of DCIS. It has been suggested that not only is breast MRI the most sensitive imaging tool for detection but it may also detect the most clinically relevant DCIS lesions. The role and outcomes of MRI in the preoperative setting for patients with DCIS remains controversial; however, several studies have shown benefit in the preoperative evaluation of extent of disease as well as predicting an underlying invasive component. The most common presentation of DCIS on MRI is nonmass enhancement (NME) in a linear or segmental distribution pattern. Maximizing breast MRI spatial resolution is therefore beneficial, given the frequent presentation of DCIS as NME on MRI. Emerging MRI techniques, such as diffusion‐weighted imaging (DWI), have shown promising potential to discriminate DCIS from benign and invasive lesions. Future opportunities including advanced imaging visual techniques, radiomics/radiogenomics, and machine learning / artificial intelligence may also be applicable to the detection and treatment of DCIS.Level of Evidence: 3Technical Efficacy Stage: 3J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2020;52:697–709.

Radiologic-pathologic correlation in breast cancer: do MRI biomarkers correlate with pathologic features and molecular subtypes?

“…The specific features of DCIS are calcifications at digital mammography (70-90% of cases [36]) and non-mass enhancement at MRI contrast-enhanced sequences (up to 81% of cases [34,[37][38][39]); our results (86.7% of DCIS presented as non-mass enhancements, p < 0.001) are in substantial agreement with those data. A second MRI feature significantly associated with DCIS was T2 isointensity (78.6%, p < 0.001) (Fig.…”

“…Most of the patients included in this study (78.2%) were affected by invasive carcinoma NST, which is the most common type of BC, 12% by ILC, and about 10% by DCIS. Our distribution substantially reflected data reported in literature [31][32][33][34][35].…”

Application of the Kaiser score to increase diagnostic accuracy in equivocal lesions on diagnostic mammograms referred for MR mammography

“…Only one lesion had a DCIS that was hormonal-positive and did not show any invasive component upon further examination of excised surgical specimen. Thus, a score of greater than 5, using a simple Kaiser score flowchart, could accurately predict DCIS in 97.6 % of cases, which is much easier than the complicated additional MR studies [34] suggested in the recent literature.…”

Review—Systematic Review on Electrochemical Biosensing of Breast Cancer miRNAs to Develop Alternative DCIS Diagnostic Tool

“…[5][6][7][8] Magnetic resonance imaging (MRI), the alternative to mammography is also radioactive, expensive, intensive, requires skilled technical assistance. 9 Furthermore, microcalcifications (MC) identification for BC screening on DCIS that is usually done via mammogram, MRI and ultrasound imaging may not be suitable for real-time clinical application and needs series of biopsies to confirm whether, the DCIS is benign or malignant, which again is a nerveracking protocol. 10 This reveals the unmet necessity to develop noninvasive, rapid, sensitive, reliable and non-radioactive method to diagnose DCIS.…”