Features of Occult Invasion in Biopsy-Proven DCIS at Breast MRI
Version of Record online: 24 OCT 2013
© 2013 Wiley Periodicals, Inc.
The Breast Journal
Volume 19, Issue 6, pages 650–658, November/December 2013
How to Cite
Wisner, D. J., Hwang, E. S., Chang, C. B., Tso, H. H., Joe, B. N., Lessing, J. N., Lu, Y. and Hylton, N. M. (2013), Features of Occult Invasion in Biopsy-Proven DCIS at Breast MRI. The Breast Journal, 19: 650–658. doi: 10.1111/tbj.12201
- Issue online: 24 OCT 2013
- Version of Record online: 24 OCT 2013
- NIH. Grant Numbers: R01 CA116182, 1 T32 EB001631-04
- ductal carcinoma in situ;
- invasive ductal carcinoma;
- invasive lobular carcinoma;
- magnetic resonance imaging;
- signal enhancement ratio
The purpose of this study is to determine if MRI BI-RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Retrospective search spanning 2000–2007 identified all core-biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship-trained in breast imaging categorized lesions according to ACR MRI BI-RADS lexicon and estimated likelihood of occult invasion. Semiquantitative signal enhancement ratio (SER) kinetic analysis was also performed. Results were compared with histopathology. 51 consecutive patients with primary core biopsy-proven DCIS and concurrent MRI were identified. Of these, 13 patients (25%) had invasion at excision. Invasion correlated significantly with presence of a mass for both readers (p = 0.012 and 0.001), rapid initial enhancement for Reader 1 (p = 0.001), and washout kinetics for Reader 2 (p = 0.012). Significant correlation between washout and invasion was confirmed by SER (p = 0.006) when threshold percent enhancement was sufficiently high (130%), corresponding to rapidly enhancing portions of the lesion. Radiologist perception of occult invasion was strongly correlated with true presence of invasion. These results provide evidence that certain BI-RADS MRI criteria, as well as radiologist perception, correlate with occult invasion after an initial core biopsy of DCIS.