Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Acad Radiol. 2019 Jun;26(6):760-765. doi: 10.1016/j.acra.2018.07.013. Epub 2018 Aug 24.
Ductal carcinoma in situ (DCIS) hinders imaging detection due to multifocal appearance and discontinuous growth. Preoperative determination of its extent is therefore challenging. Aim of this study was to investigate the additional benefit of breast magnetic resonance imaging (MRI) to mammography (MG) in the diagnosis of DCIS according to size and grading.
Retrospective analysis of 295 patients with biopsy-proven, pure DCIS. Mean patient age was 57.0 years (27-87 years). All patients obtained MG. Additional MRI was performed in 41.7% (123/295). Mammographic breast density, background parenchymal enhancement (BPE), tumor size and grading were analysed. Tumor size on MG and MRI were compared to histopathological size of the surgical specimen.
Mean tumor size was 39.6 mm. DCIS was occult on MG in 24.4% (30/123) and on MRI in 1.6% (2/123). Size was underestimated by 4.6 mm (mean) mammographically. DCIS was high grade in 54.5% (67/123), intermediate grade in 40.7% (50/123) and low grade in 4.9% (6/123). MG was exact regarding tumor size in low grade DCIS, underestimated intermediate grade DCIS by 1 mm (median) and high grade DCIS by 10.5 mm. MRI overestimated low grade DCIS by 1 mm (median), was exact regarding intermediate grade DCIS and underestimated high grade DCIS by 1 mm. BPE did not influence tumor detection and measurement.
MRI outperforms MG in the detection and size estimation of DCIS and can reduce positive margin rates.
由于多灶性和不连续性生长，导管原位癌（DCIS）阻碍了影像学检测。因此，术前确定其范围具有挑战性。本研究旨在根据大小和分级，研究乳腺磁共振成像（MRI）对乳腺 X 线摄影（MG）在 DCIS 诊断中的额外作用。
回顾性分析了 295 例经活检证实的单纯 DCIS 患者。患者平均年龄为 57.0 岁（27-87 岁）。所有患者均接受 MG 检查。41.7%（123/295）的患者进行了额外的 MRI 检查。分析了乳腺密度、背景实质增强（BPE）、肿瘤大小和分级。MG 和 MRI 上的肿瘤大小与手术标本的组织学大小进行比较。
平均肿瘤大小为 39.6mm。MG 上隐匿性 DCIS 占 24.4%（30/123），MRI 上占 1.6%（2/123）。MG 上的肿瘤大小平均低估了 4.6mm。DCIS 高级别占 54.5%（67/123），中级别占 40.7%（50/123），低级别占 4.9%（6/123）。MG 对低级别 DCIS 的肿瘤大小准确，对中级别 DCIS 低估 1mm（中位数），对高级别 DCIS 低估 10.5mm。MRI 对低级别 DCIS 高估 1mm（中位数），对中级别 DCIS 准确，对高级别 DCIS 低估 1mm。BPE 不影响肿瘤检测和测量。
MRI 在 DCIS 的检测和大小估计方面优于 MG，可降低阳性切缘率。
