Huang Yu-Ting, Cheung Yun-Chung, Lo Yung-Feng, Ueng Shir-Hwa, Kuo Wen-Ling, Chen Shin-Cheh
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taiwan, Republic of China.
Acta Radiol. 2011 Dec 1;52(10):1064-8. doi: 10.1258/ar.2011.110213. Epub 2011 Oct 3.
Under-estimation of invasion components occur occasionally at core needle diagnosed ductal carcinoma in situ (DCIS) that may change the prognosis or treatment planning.
To determine whether enhanced magnetic resonance imaging (MRI) features of biopsy-proven ductal cancers in situ help predict the under-estimation of invasive breast cancers.
After a retrospective review of the enhanced MRI features on preoperative proven breast ductal cancers in situ by biopsy, tumor morphology (mass and non-mass), enhancing curve patterns, and non-mass enhanced appearances were compared between pure ductal cancers in situ and invasive ductal cancers (IDCs) after surgery. A statistical analysis was performed, and P values <0.05 were deemed significant.
Twenty-five breast cancers from 24 women were analyzed. Eleven DCIS remained as DCISs, and 14 were upgraded to IDC after surgery. Eight of 14 IDCs (57%) and one of 11 DCISs (9%) presented as mass lesions; otherwise six (43%) IDCs and 10 (91%) DCISs were non-mass lesions (P = 0.013). Among the non-mass cancers, six of 10 DCISs (60%) were focally enhanced and six of 6 IDCs (100%) were segmentally enhanced. The overall cancer sizes measured on enhanced MRI were moderately correlated with histopathology, with a Spearman's rank correlation coefficient of 0.656 (P = 0.001). The mean diameter of the IDCs was larger than that of the pure DCISs on enhanced MRI (2.69 ± 1.42 cm for IDC and 1.62 ± 1.03 cm for DCIS; P = 0.048). The cut-off size was optimally selected at 1.95 cm with a 64% sensitivity and a 77% specificity, using a receiver-operating characteristic curve. The enhancement curves, with washout or persistent rising, were statistically insignificant (P = 0.085 and 0.93, respectively).
Enhanced MRI provided informative morphology and size features that might help to predict the underestimation of invasiveness in preoperative biopsy-proven DCIS.
在粗针穿刺活检诊断为导管原位癌（DCIS）时，偶尔会低估浸润成分，这可能会改变预后或治疗方案。
确定经活检证实的导管原位癌的增强磁共振成像（MRI）特征是否有助于预测浸润性乳腺癌的低估情况。
回顾性分析术前经活检证实的乳腺导管原位癌的增强MRI特征，比较术后纯导管原位癌与浸润性导管癌（IDC）的肿瘤形态（肿块型和非肿块型）、强化曲线类型及非肿块型强化表现。进行统计学分析，P值<0.05被认为具有统计学意义。
分析了24名女性的25例乳腺癌。11例DCIS术后仍为DCIS，14例术后升级为IDC。14例IDC中有8例（57%）表现为肿块病变，11例DCIS中有1例（9%）表现为肿块病变；否则，6例（43%）IDC和10例（91%）DCIS为非肿块病变（P = 0.013）。在非肿块型癌中，10例DCIS中有6例（60%）呈局灶性强化，6例IDC中有6例（100%）呈节段性强化。增强MRI测量的总体癌灶大小与组织病理学呈中度相关，Spearman等级相关系数为0.656（P = 0.001）。增强MRI上IDC的平均直径大于纯DCIS（IDC为2.69±1.42 cm，DCIS为1.62±1.03 cm；P = 0.048）。使用受试者工作特征曲线，最佳截断大小选择为1.95 cm，灵敏度为64%，特异性为77%。强化曲线呈廓清或持续上升的情况在统计学上无显著差异（P分别为0.085和0.93）。
增强MRI提供了有助于预测术前经活检证实的DCIS浸润性低估情况的形态学和大小特征信息。
