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Abstract

Ductal Carcinoma in Situ is a non-invasive form of breast cancer, in which malignant ductal epithelial cells proliferate, but do not invade through the basement membrane. It is a heterogeneous disease, and is a non-obligate precursor to invasive carcinoma. With the advent of screening mammography the incidence of DCIS has greatly increased. MRI is the most sensitive examination for detecting DCIS. The most common presenting morphology of DCIS is nonmass enhancement, with a clumped internal enhancement pattern and with a segmental distribution pattern. There is great variety in the kinetic patterns of DCIS, and therefore assessment must be based on morphology. Additional tools, such as diffusion weighted imaging have been shown to be promising in helping detect clinically relevant DCIS.

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References

  1. Mossa-Basha M, Fundaro GM, Shah BA, Ali S, Pantelic MV. Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation 1. Radiographics. 2010;30:1673–87.

    Article  PubMed  Google Scholar 

  2. Ozzello L. Ultrastructure of intra-epithelial carcinomas of the breast. Cancer. 1971;28:1508–15.

    Article  CAS  PubMed  Google Scholar 

  3. Recht A, Rutgers E, Fentiman I, Kurtz J, Mansel R, Sloane J. The fourth EORTC DCIS consensus meeting (Château Marquette, Heemskerk, The Netherlands, 23–24 January 1998)—Conference report. Eur J Cancer. 1998;34:1664–9.

    Article  CAS  PubMed  Google Scholar 

  4. Virnig BA, Wang S-Y, Shamilyan T, Kane RL, Tuttle TM. Ductal carcinoma in situ: risk factors and impact of screening. JNCI Monographs. 2010;2010:113–6.

    Article  Google Scholar 

  5. Lynge E, Ponti A, James T, Májek O, Euler-Chelpin MV, Anttila A, et al. Variation in detection of ductal carcinoma in situ during screening mammography: a survey within the International Cancer Screening Network. Eur J Cancer. 2014;50:185–92.

    Article  PubMed  Google Scholar 

  6. Colin C, Devouassoux-Shisheboran M, Sardanelli F. Is breast cancer overdiagnosis also nested in pathologic misclassification? Radiology. 2014;273:652–5.

    Article  PubMed  Google Scholar 

  7. Rakovitch E, Franssen E, Kim J, Ackerman I, Pignol J-P, Paszat L, et al. A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat. 2003;77:285–93.

    Article  PubMed  Google Scholar 

  8. De Morgan S, Redman S, White KJ, Cakir B, Boyages J. ‘Well, have I got cancer or haven’t I?’ The psycho-social issues for women diagnosed with ductal carcinoma in situ. Health Expect. 2002;5:310–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gotzsche PC. Breast cancer screening. International Agency for Research on Cancer (IARC) handbooks of cancer prevention. Vol. 7 Radiographics, October special issue 2013.

    Google Scholar 

  10. Erbas B, Provenzano E, Armes J, Gertig D. The natural history of ductal carcinoma in situ of the breast: a review. Breast Cancer Res Treat. 2005;97:135–44.

    Article  PubMed  Google Scholar 

  11. Nielsen M, Thomsen J, Primdahl S, Dyreborg U, Andersen J. Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies. Br J Cancer. 1987;56:814–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Welch HG. Using autopsy series to estimate the disease “Reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med. 1997;127:1023–8.

    Article  CAS  PubMed  Google Scholar 

  13. Puliti D, Duffy SW, Miccinesi G, Koning HD, Lynge E, Zappa M, et al. Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen. 2012;19:42–56.

    Article  PubMed  Google Scholar 

  14. Costarelli L, Campagna D, Mauri M, Fortunato L. Intraductal proliferative lesions of the breast—terminology and biology matter: premalignant lesions or preinvasive cancer? Int J Surg Oncol. 2012. doi:10.1155/2012/501904.

    PubMed  PubMed Central  Google Scholar 

  15. Douglas-Jones A, Gupta S, Attanoos R, Morgan J, Mansel R. A critical appraisal of six modern classifications of ductal carcinoma in situ of the breast (DCIS): correlation with grade of associated invasive carcinoma. Histopathology. 1996;29:397–409.

    Article  CAS  PubMed  Google Scholar 

  16. Elston C, Sloane J, Amendoeira I, Apostolikas N, Bellocq J, Bianchi S, et al. Causes of inconsistency in diagnosing and classifying intraductal proliferations of the breast. Eur J Cancer. 2000;36:1769–72.

    Article  CAS  PubMed  Google Scholar 

  17. Ghofrani M, Tapia B, Tavassoli FA. Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey. Virchows Arch. 2006;449:609–16.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jain RK, Mehta R, Dimitrov R, Larsson LG, Musto PM, Hodges KB, et al. Atypical ductal hyperplasia: interobserver and intraobserver variability. Mod Pathol. 2011;24:917–23.

    Article  PubMed  Google Scholar 

  19. Rosai J. Borderline epithelial lesions of the breast. Am J Surg Pathol. 1991;15:209–21.

    Article  CAS  PubMed  Google Scholar 

  20. Sloane JP, Amendoeira I, Apostolikas N, Bellocq J, Bianchi S, Boecker W, et al. Consistency achieved by 23 european pathologists in categorizing ductal carcinoma in situ of the breast using five classifications. Eur J Cancer. 2220(36):1769–72.

    Google Scholar 

  21. Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. European Commission Working Group on Breast. Hum Pathol. 1992;23:1095–7.

    Article  CAS  PubMed  Google Scholar 

  22. Tavassoli FA, Norris HJ. A comparison of the results of long-term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast. Cancer. 1990;65:518–29.

    Article  CAS  PubMed  Google Scholar 

  23. Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM. Ductal carcinoma in situ of the breast. N Engl J Med. 2004;350:1430–41.

    Article  CAS  PubMed  Google Scholar 

  24. Cady B. How to prevent invasive breast cancer: Detect and excise duct carcinoma in situ. J Surg Oncol. 1998;69:60–2.

    Article  CAS  PubMed  Google Scholar 

  25. Bjiker N, Peterse JL, Julien JP, Fentiman IS, Duval C, Di Palma S, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of Eurpoean Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol. 2001;19:2263–71.

    Article  Google Scholar 

  26. Bijker N, Meijen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, et al. Breast-conserving treatment with or without radiotherapy for ductal carcinoma in situ (DCIS): ten-year results of European Organisation for Research and Treatment of Cancer (EORTC) randomized phase III trial 10853. Eur J Cancer Suppl. 2006;4:108.

    Article  Google Scholar 

  27. Correa C, McGale P, Taylor C, Want Y, Clarke M, Davies C, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. JNCI Monographs. 2010;2010:162–77.

    Article  CAS  Google Scholar 

  28. Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 2011;12:21–9.

    Article  CAS  PubMed  Google Scholar 

  29. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N. Prevention of invasive breast cancer in women with ductal carcinoma in situ: An update of the national surgical adjuvant breast and bowel project experience. Semin Oncol. 2001;28:400–18.

    Article  CAS  PubMed  Google Scholar 

  30. Solin LJ. The impact of adding radiation treatment after breast conservation surgery for ductal carcinoma in situ of the breast. JNCI Monographs. 2010;2010:187–92.

    Article  Google Scholar 

  31. Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. JNCI J Natl Cancer Inst. 2011;103:478–88.

    Article  PubMed  Google Scholar 

  32. Solin LJ, Gray R, Baehner FL, Butler SM, Hughes LL, Yoshizawa C, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. JNCI J Natl Cancer Inst. 2013;105:701–10.

    Article  CAS  PubMed  Google Scholar 

  33. Kuhl CK, Schrading S, Bieling HB, Wardelmann E, Leutner CC, Koenig R, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370:485–92.

    Article  PubMed  Google Scholar 

  34. Lehman CD. Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. JNCI Monographs. 2010;2010:150–1.

    Article  Google Scholar 

  35. Jansen SA, Paunesku T, Fan X, Woloschak GE, Vogt S, Conzen SD, et al. Ductal carcinoma in situ: X-ray fluorescence microscopy and dynamic contrast-enhanced MR imaging reveals gadolinium uptake within neoplastic mammary ducts in a murine model 1. Radiology. 2009;253:399–406.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Jansen SA, Newstead GM, Abe H, Shimauchi A, Schmidt RA, Karczmar GS. Pure ductal carcinoma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade 1. Radiology. 2007;245:684–91.

    Article  PubMed  Google Scholar 

  37. Chan S, Chen J-H, Agrawal G, Lin M, Mehta RS, Carpenter PM, et al. Characterization of pure ductal carcinoma in situ on dynamic contrast-enhanced MR imaging: do nonhigh grade and high grade show different imaging features? J Oncol. 2010;2010:1–9.

    Article  Google Scholar 

  38. Rosen EL, Smith-Foley SA, Demartini WB, Eby PR, Peacock S, Lehman CD. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J. 2007;13:545–50.

    Article  PubMed  Google Scholar 

  39. Morris EA, Comstock CE, Lee CH, et al. ACR BI-RADS® magnetic resonance imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston: American College of Radiology; 2013.

    Google Scholar 

  40. Tozaki M, Igarashi T, Fukuda K. Breast MRI using the VIBE sequence: clustered ring enhancement in the differential diagnosis of lesions showing non-masslike enhancement. Am J Roentgenol. 2006;187:313–21.

    Article  Google Scholar 

  41. Yamada T, Mori N, Watanabe M, Kimijima I, Okumoto T, Seiji K, et al. Radiologic-pathologic correlation of ductal carcinoma in situ 1. Radiographics. 2010;30:1183–98.

    Article  PubMed  Google Scholar 

  42. Menell JH, Morris EA, Dershaw DD, Abramson AF, Brogi E, Liberman L. Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J. 2005;11:382–90.

    Article  PubMed  Google Scholar 

  43. Greenwood HI, Heller SL, Kim S, Sigmund EE, Shaylor SD, Moy L. Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 2013;33:1569–88.

    Article  PubMed  Google Scholar 

  44. Van Goethem M, Schelfout K, Kersschot E, Colpaert C, Weyler J, Verslegers I, et al. Comparison of MRI features of different grades of DCIS and invasive carcinoma of the breast. Clin Imaging. 2006;30:225–32.

    Article  Google Scholar 

  45. Rahbar H, Parsian S, Lam DL, Dontchos BN, Andeen NK, Rendi MH, et al. Can MRI biomarkers at 3 T identify low-risk ductal carcinoma in situ? Clin Imaging. 2015;40:125–9. doi:10.1016/j.clinimag.2015.07.026.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Vag T, Baltzer PAT, Dietzel M, Benndorf M, Gajda M, Camara O, et al. Kinetic characteristics of ductal carcinoma in situ (DCIS) in dynamic breast MRI using computer-assisted analysis. Acta Radiol. 2010;51:955–61.

    Article  PubMed  Google Scholar 

  47. Rahbar H, Partridge SC, Demartini WB, Gutierrez RL, Allison KH, Peacock S, et al. In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. 2012;263:374–82.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Soher BJ, Dale BM, Merkle EM. A review of MR physics: 3 T versus 1.5 T. Magn Reson Imaging Clin N Am. 2007;15:277–90.

    Article  PubMed  Google Scholar 

  49. Rahbar H, Demartini WB, Lee AY, Partridge SC, Peacock S, Lehman CD. Accuracy of 3 T versus 1.5 T breast MRI for pre-operative assessment of extent of disease in newly diagnosed DCIS. Eur J Radiol. 2015;84:611–6.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Koh D-M, Padhani AR. Diffusion-weighted MRI: a new functional clinical technique for tumour imaging. Br J Radiol BJR. 2006;79:633–5.

    Article  PubMed  Google Scholar 

  51. Chen X, Li W-L, Zhang Y-L, Wu Q, Guo Y-M, Bai Z-L. Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions. BMC Cancer 2010; doi:10.1186/1471-2407-10-693/.

  52. Fornasa F, Pinali L, Gasparini A, Toniolli E, Montemezzi S. Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation. Radiol med La radiologia medica. 2010;116:264–75.

    Article  PubMed  Google Scholar 

  53. Kul S, Cansu A, Alhan E, Dinc H, Gunes G, Reis A. Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors. Am J Roentgenol. 2011;196:210–7.

    Article  Google Scholar 

  54. Partridge SC, Demartini WB, Kurland BF, Eby PR, White SW, Lehman CD. Quantitative diffusion-weighted imaging as an adjunct to conventional breast MRI for improved positive predictive value. Am J Roentgenol. 2009;193:1716–22.

    Article  Google Scholar 

  55. Partridge SC, Demartini WB, Kurland BF, Eby PR, White SW, Lehman CD. Differential diagnosis of mammographically and clinically occult breast lesions on diffusion-weighted MRI. J Magn Reson Imaging. 2010;31:562–70.

    Article  PubMed  Google Scholar 

  56. Sinha S, Lucas-Quesada FA, Sinha U, Debruhl N, Bassett LW. In vivo diffusion-weighted MRI of the breast: potential for lesion characterization. J Magn Reson. 2002;15:693–704.

    Article  Google Scholar 

  57. Yabuuchi H, Matsuo Y, Kamitani T, Setoguchi T, Okafuji T, Soeda H, et al. Non-mass-like enhancement on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. Eur J Radiol. 2010;75:126–32. doi:10.1016/j.ejrad.2009.09.013.

  58. Rahbar H, Partridge SC, Eby PR, Demartini WB, Gutierrez RL, Peacock S, et al. Characterization of ductal carcinoma in situ on diffusion weighted breast MRI. Eur Radiol. 2011;21:2011–9.

    Article  PubMed  Google Scholar 

  59. Iima M, Bihan DL, Okumura R, Okada T, Fujimoto K, Kanao S, et al. Apparent diffusion coefficient as an MR imaging biomarker of low-risk ductal carcinoma in situ: a pilot study. Radiology. 2011;260:364–72.

    Article  PubMed  Google Scholar 

  60. Hahn SY, Han B-K, Ko EY, Shin JH, Hwang J-Y, Nam M. MR features to suggest microinvasive ductal carcinoma of the breast: can it be differentiated from pure DCIS? Acta Radiol. 2013;54:742–8.

    Article  PubMed  Google Scholar 

  61. Intra M, Rotmensz N, Veronesi P, Colleoni M, Iodice S, Paganelli G, et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast. Ann Surg. 2008;247:315–9.

    Article  PubMed  Google Scholar 

  62. Wisner DJ, Hwang ES, Chang CB, Tso HH, Joe BN, Lessing JN, et al. Features of occult invasion in biopsy-proven DCIS at breast MRI. Breast J. 2013;19:650–8.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Goto M, Yuen S, Akazawa K, Nishida K, Konishi E, Kajihara M, et al. The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy. Eur Radiol. 2011;22:1255–64.

    Article  PubMed  Google Scholar 

  64. Nori J, Meattini I, Giannotti E, Abdulcadir D, Mariscotti G, Calabrese M, et al. Role of preoperative breast MRI in ductal carcinoma in situ for prediction of the presence and assessment of the extent of occult invasive component. Breast J. 2014;20:243–8.

    Article  PubMed  Google Scholar 

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Correspondence to Heather I. Greenwood MD .

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Greenwood, H.I., Joe, B.N. (2017). In Situ Disease on Breast MRI. In: Heller, S., Moy, L. (eds) Breast Oncology: Techniques, Indications, and Interpretation. Springer, Cham. https://doi.org/10.1007/978-3-319-42563-4_9

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