The Clinical Significance of Breast MRI in the Management of Ductal Carcinoma In Situ Diagnosed on Needle Biopsy

Miyashita, Minoru; Amano, Goro; Ishida, Toru; Tamaki, Kentaro; Uchimura, Fumiaki; Ono, T.; Yajima, Mioko; Kuriya, Yoshiki; Ohuchi, Noriaki

doi:10.1093/jjco/hyt055

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…On the other hand, our finding that the sensitivity of MRI is too low to be of use in identifying patients with occult breast cancer is in contrast with several studies that concluded that it is possible to use MRI to detect some of the occult breast cancers, without attempting to determine the sensitivity of MRI in doing this [9,12,13,15,16]. In studies of Goto et al and Harowitz et al, the sensitivity of MRI was presented as ROC curves with an AUC of 0.71 and 0.719, respectively, [10,14], which is in line with our finding of an AUC of 0.73.…”

Section: Discussioncontrasting

confidence: 64%

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Bekkum

Braak

Plaisier

et al. 2020

European Journal of Surgical Oncology

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Background: In 20e25% of patients with biopsy-proven DCIS underestimation occurs. Sentinel lymph node biopsy (SLNB) is offered to patients with biopsy-proven ductal carcinoma in situ (DCIS) and a high risk of occult invasive cancer. However, assessment of high risk is controversial. We aimed to improve selection of patients for SLNB with preoperative breast magnetic resonance imaging (MRI). Methods: In this prospective observational study, MRI was offered to all subsequent patients with a biopsy-proven DCIS admitted to a large Dutch teaching hospital between April 2012 and March 2017. MRI images were analysed for signs of invasive cancer and the results were compared with the pathologic results after surgical treatment. The diagnostic accuracy of additional MRI in detecting occult invasive cancer was determined. Results: Of 211 patients eligible for additional MRI analysis, 149 underwent breast MRI. The majority (67%) received breast-conserving therapy, and the underestimation rate was 20%. Subsequent to MRI analysis, 20 additional invasive diagnostic procedures were performed. Occult invasive cancer was suspected on MRI in 46 patients (31%) and was confirmed in 18 (12%). In this study, breast MRI had a sensitivity of 67%, a specificity of 77%, and a true negative rate of 91%. Conclusion: Preoperative breast MRI cannot reliably predict the presence of invasive cancer in patients with biopsy proven DCIS. Therefore, it cannot be used to in the selection of patients for a SLNB.

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Section: Discussioncontrasting

confidence: 64%

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Bekkum

Braak

Plaisier

et al. 2020

European Journal of Surgical Oncology

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“…We found a predominance of nonmass enhancement as a feature of ADH as well as DCIS. Our rate of non-mass enhancement among DCIS is in the upper limit of the 70%-80% rate of nonmass enhancement encountered in MR studies designed for diagnosing or excluding invasive disease in patients with DCIS diagnosed by means of imageguided biopsy (30)(31)(32)(33).…”

Section: Multivariate Analysismentioning

confidence: 83%

Underestimation Rate at MR Imaging–guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies

Verheyden¹,

Pages-Bouic²,

Balleyguier³

et al. 2016

Radiology

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Purpose To assess the rate of underestimation of atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) at magnetic resonance (MR) imaging-guided vacuum-assisted breast biopsy and to explore the imaging, demographic, and histologic characteristics associated with lesion upgrade after surgery. Materials and Methods This retrospective study had institutional review board approval, and the need to obtain informed patient consent was waived. A total of 1509 MR imaging-guided vacuum-assisted biopsy procedures were performed in nine centers. A diagnosis of ADH was obtained after biopsy in 72 cases, and a diagnosis of DCIS was obtained in 118 cases. Pearson χ and Fisher tests were used to assess the association between demographic, MR imaging, and biopsy features and lesion upgrade. Univariate statistical analyses were performed, and each significant parameter was entered into a multivariate logistic regression analysis. Results Surgical excision was performed in 66 of the 72 ADH cases and in 117 of 118 DCIS cases. The ADH and DCIS underestimation rates were 25.8% (17 of 66) and 23.1% (27 of 117), respectively. Underestimation was 5.6-fold (odds ratio [OR] = 5.6; 95% confidence interval [CI]: 1.7, 18.3) and 3.6-fold (OR = 3.6; 95% CI: 1.2, 10) more likely in mass (n = 20 for ADH and n = 20 for DCIS) than in non-mass (n = 46 for ADH and n = 97 for DCIS), compared with nonunderestimation, in ADH and DCIS respectively. At multivariate analysis, the use of a 9- or 10-gauge needle versus a 7- or 8-gauge needle was also an independently associated with underestimation when a diagnosis of ADH was made at MR imaging-guided biopsy. No other parameters were associated with of ADH or DCIS upgrade at surgery. Conclusion The rates of underestimation in ADH and DCIS diagnosed at MR imaging-guided vacuum-assisted biopsy were high, at around 25%, and were significantly associated with the presence of a mass at MR imaging. RSNA, 2016.

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“…When planning a surgical strategy for treating preoperatively diagnosed cases of DCIS, it is clinically important to be able to more accurately predict the presence or absence of unexpected invasive disease in surgical specimens [28].…”

Section: Discussionmentioning

confidence: 99%

Characterization of Suspicious Breast Lesions with Dynamic Contrast enhanced MRI In comparison to Conventional mammography and Ultrasonography

Ghazala¹

2016

JCPCR

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This study included thirty three patients with suspicious breast lesions. For every patient; Mammography, Ultrasonography and Dynamic MRI were done.Our results indicate that the sensitivity of breast imaging can be increased by complementary use of MRI. For patients in whom the status of breast lesion remains unclear, MRI, though most expensive among all other complementary diagnostic modalities, it reduces the number of unnecessary biopsies and diagnostic challenges. Keywords: Mammography; Breast ultrasound; Dynamic MRI breast Characterization of Suspicious Breast Lesions with Dynamic Contrast enhanced MRI In comparison to Conventional mammography and Ultrasonography 2/19Copyright: ©2016 Ghazala et al. Citation MethodsMammography was conducted for all patients using digital mammography in both medio lateral oblique and craniocaudal views with spot compression magnification view when necessary.Mammographic images were analyzed regarding the presence of masses, architectural distortion, asymmetrical density and calcification. In detected masses their side, site, number, margins and density were evaluated, while in case of micro calcification their shape and distribution were assessed.Then classification of breast lesions was based on the Breast Imaging Reporting and Data System (BI-RADS).Then ultrasound was performed for all patients using a high frequency probe (7.5MHZ), scanning was done in two orthogonal (longitudinal and transverse) planes.Masses were evaluated by US considering BI-RADS US lexicon regarding: their shape, orientation, margins, echopattern (anechoic, hyperechoic, complex, hypoechoic, isoechoic), lesion boundary (abrupt interface, echogenic halo) and presence or absence of acoustic shadowing or enhancement.Then all patients were referred for further MRI examination. MR imaging protocolDynamic MR imaging was performed with high field strength 1.5 Tesla on (Philips Ingenia system) using dedicated double breast coil.Coronal T1 weighted spin echo sequence was carried out for localization purpose and followed by plain sequences using T1weighted fast spin echo sequence (TR=125msec.,TE= 5.3msec.),in addition to T2 weighted fast spin echo sequence (TR=3740mesc.,TE=90 msec.) in axial orientation.A bolus of gadolinium dimeglumine (Gd-DTPA) (Magnavist, Schering AG Berlin, Germany) was injected manually intravenous at a dose of (0.1mmol/kg) followed by saline flush to ensure that contrast -enhanced images could be obtained immediately after contrast agent injection.Dynamic T1 WIs then performed using Gradient echo T1 weighted image with fat suppression at the following time points: 1 minute, 2 min., 4 min. and 7 min.Post processing image subtraction was obtained between the post contrast imaging showing maximum enhancement and pre-contrast images (in the same axial plane), using the software subtraction function available on the work station.Quantitative analysis was done by placing the region of interest (ROI) at the most enhanced part within the lesion result in automatically created time/ signal...

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The Clinical Significance of Breast MRI in the Management of Ductal Carcinoma In Situ Diagnosed on Needle Biopsy

Cited by 9 publications

References 23 publications

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Underestimation Rate at MR Imaging–guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies

Characterization of Suspicious Breast Lesions with Dynamic Contrast enhanced MRI In comparison to Conventional mammography and Ultrasonography

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