Greenwood Heather I, Maldonado Rodas Cristian K, Freimanis Rita I, Glencer Alexa C, Miller Phoebe N, Mukhtar Rita A, Brabham Case, Yau Christina, Rosenbluth Jennifer M, Hirst Gillian L, Campbell Michael J, Borowsky Alexander, Hylton Nola, Esserman Laura J, Basu Amrita
University of California San Francisco Department of Radiology, San Francisco, CA, USA.
University of California San Francisco Department of Surgery, San Francisco, CA, USA.
NPJ Breast Cancer. 2024 Aug 4;10(1):71. doi: 10.1038/s41523-024-00677-9.
New approaches are needed to determine which ductal carcinoma in situ (DCIS) is at high risk for progression to invasive ductal carcinoma (IDC). We retrospectively studied DCIS patients who declined surgery (2002-2019), and received endocrine therapy (ET) and breast MRI. Baseline MRI and changes at 3 months and 6 months were analyzed by recursive partitioning to stratify IDC risk. Sixty-two patients (63 DCIS; 1 bilateral) with a mean follow-up of 8.5 years were included. Fifty-one percent remained on active surveillance (AS) without evidence of IDC, with a mean duration of 7.6 years. A decision tree based on MRI features of lesion distinctness and background parenchymal enhancement (BPE) at baseline and change after 3 months of ET stratified patients into low, intermediate, and high risk for progression to IDC. MRI imaging features in patients treated with ET and undergoing AS, may help determine which DCIS lesions are at low versus high risk for IDC.
需要新的方法来确定哪些导管原位癌（DCIS）进展为浸润性导管癌（IDC）的风险较高。我们回顾性研究了2002年至2019年期间拒绝手术、接受内分泌治疗（ET）和乳腺MRI检查的DCIS患者。通过递归分割分析基线MRI以及3个月和6个月时的变化，以对IDC风险进行分层。纳入了62例患者（63处DCIS；1例双侧），平均随访8.5年。51%的患者继续接受主动监测（AS），未发现IDC证据，平均持续时间为7.6年。基于基线时病变清晰度和背景实质强化（BPE）的MRI特征以及ET治疗3个月后的变化的决策树，将患者分为进展为IDC的低、中、高风险组。接受ET治疗并进行AS的患者的MRI成像特征，可能有助于确定哪些DCIS病变发展为IDC的风险较低或较高。
