MRI of the breast for the detection and assessment of the size of ductal carcinoma in situ

Abstract

Objective: The aim of the study was to compare the accuracy of magnetic resonance imaging (MRI) and mammography for the detection and assessment of the size of ductal carcinoma in situ (DCIS).

Materials and methods: The preoperative contrast-enhanced MRI and mammography were analyzed in respect of the detection and assessment of the size of DCIS in 72 patients (age range: 30-67 years, mean age: 47 years). The MRI and mammographic measurements were compared with the histopathologic size with using the Pearson's correlation coefficients and the Mann-Whitney u test. We evaluated whether the breast density, the tumor nuclear grade, the presence of comedo necrosis and microinvasion influenced the MRI and mammographic size estimates by using the chi-square test.

Results: Of the 72 DCIS lesions, 68 (94%) were detected by MRI and 62 (86%) were detected by mammography. Overall, the Pearson's correlation of the size between MRI and histopathology was 0.786 versus 0.633 between mammography and histopathology (p < 0.001). MRI underestimated the size by more than 1 cm (including false negative examination) in 12 patients (17%), was accurate in 52 patients (72%) and overestimated the size by more than 1 cm in eight patients (11%) whereas mammography underestimated the size in 25 patients (35%), was accurate in 31 patients (43%) and overestimated the size in 16 patients (22%). The MRI, but not the mammography, showed significant correlation for the assessment of the size of tumor in noncomedo DCIS (p < 0.001 vs p = 0.060). The assessment of tumor size by MRI was affected by the nuclear grade (p = 0.008) and the presence of comedo necrosis (p = 0.029), but not by the breast density (p = 0.747) or microinvasion (p = 0.093).

Conclusion: MRI was more accurate for the detection and assessment of the size of DCIS than mammography.

Fig. 1

Graph showing the correlation between the histopathologically determined DCIS size and the corresponding DCIS size as measured by MRI and mammography. The mean absolute difference in the size between imaging and histopathology was 0.8 cm (0-6.5 cm) by MRI and 1.5 cm (0-7.3 cm) by mammography. DCIS = Ductal carinoma in situ, MRI = Magnetic resonance imaging, MMG = Mammography.

Fig. 2

A 45-year-old woman with a 5 cm high grade, comedo type DCIS, which was more accurately assessed by MRI than by mammography. A. Spot-magnification mediolateral oblique mammogram shows a 1.1 cm cluster of the pleomorphic microcalcifications (arrow) in the left breast. The metallic marker is on the palpable area. B. Dynamic contrast-enhanced sagittal subtraction MR image shows a 5 cm sized, segmentally distributed, heterogeneous enhancing lesion (arrows) in the left breast.

Fig. 3

A 43-year-old woman with a 2 cm high grade, comedo type DCIS, which was more accurately assessed by mammography than by MRI. A. Spot-magnification mediolateral oblique mammogram shows a 1.4 cm segmental distribution of the pleomorphic microcalcifications (arrow) in the right breast. B. Dynamic contrast-enhanced sagittal subtraction MR image shows a 0.5 cm sized, irregular enhancing lesion (arrow) in the right breast.

Fig. 4

A 33-year-old woman with a 2.7 cm high grade, comedo type DCIS, which was accurately assessed by both MRI and mammography. A. Spot-magnification mediolateral oblique mammogram shows a 2.7 cm segmental distribution of the pleomorphic microcalcifications (arrow) in the left breast. B, C. Dynamic contrast-enhanced sagittal subtraction MR images shows a 2.7 cm sized, clumped ductal enhancement (arrows) in the left breast.