García Ruiz Cristina, Saidi Laila Zitan, Zambrana Aguilar Lucía, Moreira Cabrera Maricela, Carvia Ponsaille Carolina, Vázquez Sousa Rosa, Martínez Porras Carmen, Murillo-Cancho Antonio Fernando
Diagnostic Radiology Attending, Department of Radiology, Torrecárdenas University, 04009 Almería, Spain.
Diagnostic Radiology Attending, Department of Radiology, Poniente University Hospital, 04700 Almería, Spain.
J Clin Med. 2025 Apr 20;14(8):2842. doi: 10.3390/jcm14082842.
The use of dynamic magnetic resonance imaging (MRI) for the evaluation, detection, and characterization of ductal carcinoma in situ (DCIS) has been increasing; however, its application in this context remains controversial and uncertain. A retrospective study including women with pure DCIS, confirmed between January 2012 and December 2022 using ultrasound-guided core-needle biopsy (CNB) or stereotaxy-guided vacuum-assisted biopsy (VAB), was conducted. Mammography, ultrasound (US), and MRI of DCIS lesions were evaluated according to histological grade. The size of the DCIS, as assessed by mammography, US, MRI, and final surgical histopathology, was compared using Lin's concordance correlation and Bland-Altman plots. : A total of 144 women (mean age 55.5 ± 10.3 years) with histopathological diagnoses of pure DCIS and no evidence of infiltration in the percutaneous biopsy were included in the study. Microcalcifications were the most prevalent feature observed in mammography (82.63%). Round/punctate morphology was more common in low-grade lesions, while fine pleomorphic morphology was more frequent in medium- and high-grade lesions. Lesions manifesting as microcalcifications only on mammography were significantly associated with intermediate and high-nuclear grade DCIS ( = 0.005). The most common MRI manifestation of DCIS was non-mass enhancement (86.11%). A total of 141 lesions showed enhancement with MRI (sensibility 97.92%). There were no significant differences ( = 0.29) between negative and positive enhancement with MRI and the histological grade of the lesions. There were no significant differences ( = 0.49) between the type of enhancement curve with MRI and the histological grade. Preoperative MRI detected additional malignancies (multifocal, multicentric, or bilateral) in 35 patients (24.31%). DCIS demonstrated enhancement with MRI regardless of histological grade but overestimated the size of the lesions in low-nuclear-grade DCIS. Preoperative MRI identified additional malignancies (multifocal, multicentric, and bilateral lesions) in 24 patients (16.67%), which were confirmed by histopathological examination. These malignancies were either undetected or not visible with mammography and ultrasound. However, MRI also overestimated the size of the DCIS, leading to three unnecessary mastectomies in our study.
动态磁共振成像（MRI）用于原位导管癌（DCIS）的评估、检测和特征描述的应用一直在增加；然而，其在这种情况下的应用仍存在争议且不确定。我们进行了一项回顾性研究，纳入了2012年1月至2022年12月期间经超声引导下粗针穿刺活检（CNB）或立体定向引导下真空辅助活检（VAB）确诊为纯DCIS的女性患者。根据组织学分级对DCIS病变的乳腺X线摄影、超声（US）和MRI进行评估。使用林氏一致性相关性和布兰德-奥特曼图比较了通过乳腺X线摄影、US、MRI和最终手术组织病理学评估的DCIS大小。：本研究共纳入144名女性（平均年龄55.5±10.3岁），其组织病理学诊断为纯DCIS，经皮活检无浸润证据。微钙化是乳腺X线摄影中最常见的特征（82.63%）。圆形/点状形态在低级别病变中更常见，而细多形性形态在中级和高级别病变中更频繁。仅在乳腺X线摄影上表现为微钙化的病变与中级和高级别核DCIS显著相关（P = 0.005）。DCIS最常见的MRI表现为非肿块强化（86.11%）。共有141个病变在MRI上显示强化（敏感性97.92%）。MRI阴性和阳性强化与病变的组织学分级之间无显著差异（P = 0.29）。MRI强化曲线类型与组织学分级之间无显著差异（P = 0.49）。术前MRI在35例患者（24.31%）中检测到额外的恶性肿瘤（多灶性、多中心性或双侧性）。DCIS无论组织学分级如何在MRI上均显示强化，但在低级别核DCIS中高估了病变大小。术前MRI在24例患者（16.67%）中识别出额外的恶性肿瘤（多灶性、多中心性和双侧性病变），经组织病理学检查证实。这些恶性肿瘤在乳腺X线摄影和超声检查中未被检测到或不可见。然而，MRI也高估了DCIS的大小，导致我们的研究中有3例不必要的乳房切除术。
