1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
2 Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
AJR Am J Roentgenol. 2019 Apr;212(4):919-924. doi: 10.2214/AJR.18.20306. Epub 2019 Feb 4.
Treatment of ductal carcinoma in situ (DCIS) is controversial given the variable recurrence and progression to invasive carcinoma. Identifying women who would benefit from adjuvant radiation therapy on the basis of their recurrence risk may allow more individualized management strategies. The Oncotype DX Breast DCIS Score-which we refer to here as the "DCIS score"-is a validated surrogate marker of local recurrence. This study evaluated the association between BI-RADS mammographic calcification descriptors and the DCIS score.
Fifty-eight women diagnosed with DCIS presenting with calcifications who had Oncotype DX Breast DCIS assay results were identified. Pretreatment BI-RADS mammographic calcification features were collected including morphology, distribution, and maximum span. The association between calcification descriptors and DCIS score was assessed with logistic regression modeling. Mean DCIS scores were calculated for calcification features significantly associated with DCIS score. All analyses were adjusted for patient age, DCIS grade, and progesterone receptor status.
Of the suspicious calcifications that proved to represent DCIS, 19.0% were amorphous; 25.9%, coarse heterogeneous; 39.7%, fine pleomorphic; and 15.5%, fine linear or fine linear branching in morphology. The mean DCIS scores by calcification morphology were 22.3, 35.5, 36.7, and 44.1, respectively. Amorphous calcification morphology had a significantly lower adjusted mean DCIS score compared with fine pleomorphic morphology (p = 0.01) and fine linear or fine linear branching morphology (p = 0.02). The adjusted odds ratio (OR) of intermediate or high risk of recurrence (defined as a DCIS score ≥ 39) was significantly higher for women with fine pleomorphic calcifications (OR = 53.1, p = 0.01) and for those with fine linear or fine linear branching calcifications (OR = 24.0, p = 0.04) than for women with amorphous calcifications.
Women with amorphous calcification morphology had the lowest DCIS scores compared with women with fine pleomorphic and fine linear or fine linear branching morphologies. Both fine pleomorphic and fine linear or fine linear branching morphologies were associated with higher odds of intermediate or high risk of recurrence. These findings suggest mammographic features are potential biomarkers of DCIS recurrence and could help individualize treatment decisions.
由于导管原位癌（DCIS）的复发和进展为浸润性癌的情况各不相同，因此对其治疗存在争议。根据复发风险，确定哪些女性可能从辅助放疗中获益，可能有助于制定更个体化的管理策略。Oncotype DX 乳腺 DCIS 评分——我们在此称之为“DCIS 评分”——是局部复发的一种经验证的替代标志物。本研究评估了 BI-RADS 乳腺钙化描述符与 DCIS 评分之间的关系。
共纳入 58 例经病理证实为 DCIS 伴钙化且接受 Oncotype DX 乳腺 DCIS 检测的患者。收集患者术前 BI-RADS 乳腺钙化特征，包括形态、分布和最大跨度。采用 logistic 回归模型评估钙化描述符与 DCIS 评分之间的关系。对与 DCIS 评分显著相关的钙化特征进行计算，得出平均 DCIS 评分。所有分析均调整了患者年龄、DCIS 分级和孕激素受体状态。
在经证实为 DCIS 的可疑钙化中，19.0%为无定形；25.9%为粗颗粒不均匀；39.7%为细颗粒多形性；15.5%为细线性或细线性分支形态。形态学上的平均 DCIS 评分分别为 22.3、35.5、36.7 和 44.1。无定形钙化形态的平均 DCIS 评分明显低于细颗粒多形性形态（p = 0.01）和细线性或细线性分支形态（p = 0.02）。具有中间或高复发风险（定义为 DCIS 评分≥39）的女性中，细颗粒多形性钙化（OR = 53.1，p = 0.01）和细线性或细线性分支钙化（OR = 24.0，p = 0.04）的比值比明显高于无定形钙化的女性。
与细颗粒多形性和细线性或细线性分支形态的女性相比，无定形钙化形态的女性 DCIS 评分最低。细颗粒多形性和细线性或细线性分支形态均与中间或高复发风险的几率增加相关。这些发现表明，乳腺影像学特征可能是 DCIS 复发的潜在生物标志物，有助于制定个体化的治疗决策。
