Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
Br J Radiol. 2022 Feb 1;95(1130):20211013. doi: 10.1259/bjr.20211013. Epub 2021 Dec 21.
The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma (NCDCIS). The study tested the hypothesis that lesions with sonographic findings have higher upgrade rate compared to lesions seen on mammography or MRI only.
This retrospective study included patients with ductal carcinoma (DCIS) diagnosed by image-guided core breast biopsy from December 2009 to April 2018. Patients with microcalcifications on mammography or concurrent ipsilateral cancer on core biopsy were excluded. An upgrade was defined as surgical pathology showing microinvasive or invasive cancer.
A total of 71 lesions constituted the study cohort. 62% of cases (44/71) had a mammographic finding, and 38% (27/71) of mammographically occult lesions had findings on either ultrasound, MRI, or both. Of the 67 cases that underwent sonography, a mass was noted in 56/67 (83.6%) cases and no sonographic correlate was identified in 11/67 (16.4%) cases. 21% (15/71) of lesions were upgraded on final surgical pathology. The upgrade rate of patients with sonographic correlate was 27% (15/56) with mammographic findings only was 0% (0/11).
DCIS should be considered in the differential diagnosis of architectural distortion, asymmetries, focal asymmetries, and masses, even in the absence of microcalcifications. NCDCIS diagnosed by ultrasound may be an independent risk factor for upgrade.
Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.
本研究旨在评估非钙化性导管癌（NCDCIS）的影像学和病理学特征及升级率。本研究检验了一个假设，即与仅在乳房 X 线摄影或 MRI 上看到的病变相比，具有超声表现的病变具有更高的升级率。
本回顾性研究纳入了 2009 年 12 月至 2018 年 4 月期间经影像引导核心乳腺活检诊断为导管癌（DCIS）的患者。排除了在乳房 X 线摄影上有微钙化或核心活检中同时存在同侧癌症的患者。升级定义为手术病理显示微浸润性或浸润性癌。
共有 71 个病变构成了研究队列。62%的病例（44/71）有乳房 X 线摄影表现，38%（27/71）的乳房 X 线摄影隐匿性病变在超声、MRI 或两者上均有表现。在进行超声检查的 67 例病例中，56/67（83.6%）病例可见肿块，11/67（16.4%）病例未见超声相关表现。最终手术病理有 21%（15/71）的病变升级。有超声相关表现的患者升级率为 27%（15/56），仅存在乳房 X 线摄影表现的患者升级率为 0%（0/11）。
即使没有微钙化，在诊断为结构扭曲、不对称、局灶性不对称和肿块时，也应考虑到 DCIS 的鉴别诊断。通过超声诊断的 NCDCIS 可能是升级的独立危险因素。
放射科医生必须了解 DCIS 的影像学特征，并在通过超声诊断 NCDCIS 时考虑到更高的升级率。
