Role of breast MRI in early detection and evaluation of Ductal Carcinoma in Situ
Muhammad Atif Ibrahim Alsayyad;
Abstract
DCIS is a common non-invasive malignancy that may be a primary tumor or be associated with other focal higher-grade breast cancer lesions. Early detection is crucial because of the large DCIS proportion that progresses to invasive breast cancer.
Although diagnostic mammography still remains the primary technique in routine screening programs to identify DCIS, in many cases it is not accurate either in screening dense breasts, in assessing the real cancer extent or in detecting multifocal lesions.
Breast MRI plays a role in the detection of high-grade DCIS, which most frequently appears as non-mass clumped enhancement pattern, in a ductal or segmental distribution, with unreliable patterns of enhancement kinetics, most commonly showing rapid initial enhancement, followed by variable delayed phase enhancement patterns. Thus, the image interpretation should be based on the morphologic characteristics rather than the enhancement kinetics of the lesion.
Two distinct patterns of neovascularization may occur in DCIS: peri-ductal and stromal. The peri-ductal pattern manifests as a dense rim-like network of micro-vessels adjacent to the basement membrane of a duct. The stromal pattern is characterized by a more diffuse increase in vascularity of the stroma between DCIS lesions.
Recognizing the potential artifacts and pitfalls associated with breast MR imaging is necessary for appropriate and accurate interpretation of the results of this important imaging tool.
The sensitivity of breast MRI for the detection of DCIS, especially for high grade ones, is the greatest of all imaging techniques, however this increased detection has not yet been correlated with a decrease in mortality, so when the findings of conventional imaging are inconclusive (i.e. BI-RADS 0), MRI can be used as a problem-solving modality but it is not recommended to be used as a primary modality.
In the preoperative setting of DCIS patients, breast MRI can determine the size, the extent of disease, and the presence of multifocality and multicentricity, in the ipsilateral or contralateral side of the breast, more accurate than standard mammography and physical examination, however, this accuracy remains to be shown conclusively in the recurrence rates following surgery.
Although diagnostic mammography still remains the primary technique in routine screening programs to identify DCIS, in many cases it is not accurate either in screening dense breasts, in assessing the real cancer extent or in detecting multifocal lesions.
Breast MRI plays a role in the detection of high-grade DCIS, which most frequently appears as non-mass clumped enhancement pattern, in a ductal or segmental distribution, with unreliable patterns of enhancement kinetics, most commonly showing rapid initial enhancement, followed by variable delayed phase enhancement patterns. Thus, the image interpretation should be based on the morphologic characteristics rather than the enhancement kinetics of the lesion.
Two distinct patterns of neovascularization may occur in DCIS: peri-ductal and stromal. The peri-ductal pattern manifests as a dense rim-like network of micro-vessels adjacent to the basement membrane of a duct. The stromal pattern is characterized by a more diffuse increase in vascularity of the stroma between DCIS lesions.
Recognizing the potential artifacts and pitfalls associated with breast MR imaging is necessary for appropriate and accurate interpretation of the results of this important imaging tool.
The sensitivity of breast MRI for the detection of DCIS, especially for high grade ones, is the greatest of all imaging techniques, however this increased detection has not yet been correlated with a decrease in mortality, so when the findings of conventional imaging are inconclusive (i.e. BI-RADS 0), MRI can be used as a problem-solving modality but it is not recommended to be used as a primary modality.
In the preoperative setting of DCIS patients, breast MRI can determine the size, the extent of disease, and the presence of multifocality and multicentricity, in the ipsilateral or contralateral side of the breast, more accurate than standard mammography and physical examination, however, this accuracy remains to be shown conclusively in the recurrence rates following surgery.
Other data
| Title | Role of breast MRI in early detection and evaluation of Ductal Carcinoma in Situ | Other Titles | دور الرنين المغناطيسي في التشخيص المبكر والتقييم للأقنية السرطانية الكامنة فى الثدى | Authors | Muhammad Atif Ibrahim Alsayyad | Issue Date | 2015 |
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