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European Radiology

, Volume 22, Issue 7, pp 1504–1511 | Cite as

MRI of the breast in patients with DCIS to exclude the presence of invasive disease

  • Eline E. DeurlooEmail author
  • Jincey D. Sriram
  • Hendrik J. Teertstra
  • Claudette E. Loo
  • Jelle Wesseling
  • Emiel J. Th. Rutgers
  • Kenneth G. A. Gilhuijs
Breast

Abstract

Objectives

Core biopsy underestimates invasion in more than 20% of patients with preoperatively diagnosed ductal carcinoma in situ (DCIS) without evidence of invasion (pure DCIS). The aim of the current study was to evaluate the efficacy of preoperative magnetic resonance imaging (MRI) to discriminate between patients with DCIS who are at high risk of invasive breast cancer and patients at low risk.

Methods

One hundred and twenty-five patients, preoperatively diagnosed with pure DCIS (128 lesions; 3 bilateral) by core-needle biopsy, were prospectively included. Clinical, mammographic, histological (core biopsy) and MRI features were assessed. All patients underwent breast surgery. Analyses were performed to identify features associated with presence of invasion.

Results

Eighteen lesions (14.1%) showed invasion on final histology. Seventy-three lesions (57%) showed suspicious enhancement on MRI with a type 1 (n = 12, 16.4%), type 2 (n = 19, 26.0%) or type 3 curve, respectively (n = 42, 57.5%). At multivariate analysis, the most predictive features for excluding presence of invasive disease were absence of enhancement or a type 1 curve on MRI (negative predictive value 98.5%; AZ 0.80, P = 0.00006).

Conclusion

Contrast medium uptake kinetics at MRI provide high negative predictive value to exclude presence of invasion and may be useful in primary surgical planning in patients with a preoperative diagnosis of pure DCIS.

Key Points

It is important to determine invasion in breast DCIS.

MRI contrast medium uptake kinetics can help exclude the presence of invasion.

However, the positive predictive value for the presence of invasion is limited.

MRI features were more accurate at predicting invasion than mammographic features alone.

Keywords

Breast DCIS MRI Invasive ductal carcinoma Axillary lymph node dissection 

Notes

Acknowledgements

This study was financially supported in part by the Dutch Cancer Foundation (NKB 2004–3082).

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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Eline E. Deurloo
    • 1
    • 2
    Email author
  • Jincey D. Sriram
    • 3
  • Hendrik J. Teertstra
    • 2
  • Claudette E. Loo
    • 2
  • Jelle Wesseling
    • 4
  • Emiel J. Th. Rutgers
    • 3
  • Kenneth G. A. Gilhuijs
    • 2
    • 5
  1. 1.Department of RadiologyAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of RadiologyThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of SurgeryThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  4. 4.Department of PathologyThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  5. 5.Department of Radiology, Image Sciences InstituteThe University Medical Center UtrechtUtrechtThe Netherlands

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