Non-calcified Ductal Carcinoma In Situ Research Articles

Role of contrast-enhanced mammography in the preoperative detection of ductal carcinoma in situ of the breasts: a comparison with low-energy image and magnetic resonance imaging.

To compare contrast-enhanced mammography (CEM) with low-energy image (LEI) alone and with magnetic resonance imaging (MRI) in the preoperative diagnosis of ductal carcinoma in situ (DCIS). In this single-center retrospective study, we reviewed 98 pure DCIS lesions in 96 patients who underwent CEM and MRI within 2weeks preoperatively. The diagnostic performances of each imaging modality, lesion morphology, and extent were evaluated. The sensitivity of CEM to DCIS was similar to that of MRI (92.9% vs. 93.9%, p = 0.77) and was significantly higher than that of LEI alone (76.5%, p = 0.002). The sensitivity of CEM to calcified DCIS (92.4%) was not significantly different from LEI alone (92.4%) and from MRI (93.9%, p = 1.00). However, CEM contributed to the simultaneous comparison of calcifications with enhancements. CEM had considerably higher sensitivity compared with LEI alone (93.8% vs. 43.8%, p < 0.001) and performed similarly to MRI (93.8%, p = 1.00) for noncalcified DCIS. All DCIS lesions were enhanced in MRI, whereas 94.9% (93/98) were enhanced in CEM. Non-mass enhancement was the most common presentation (CEM 63.4% and MRI 66.3%). The difference between the lesion size on each imaging modality and the histopathological size was smallest in MRI, followed by CEM, and largest in LEI. CEM was more sensitive than LEI alone and comparable to MRI in DCIS diagnosis. The enhanced morphology of DCIS in CEM was consistent with that in MRI. CEM was superior to LEI alone in size measurement of DCIS. This study investigated the value of CEM in the diagnosis and evaluation of DCIS, aiming to offer a reference for the selection of examination methods for DCIS and contribute to the early diagnosis and precise treatment of DCIS. • DCIS is an important indication for breast surgery. Early and accurate diagnosis is crucial for DCIS treatment and prognosis. • CEM overcomes the deficiency of mammography in noncalcified DCIS diagnosis, exhibiting similar sensitivity to MRI; and CEM contributes to the comparison of calcification and enhancement of calcified DCIS, thereby outperforming MRI. • CEM is superior to LEI alone and slightly inferior to MRI in the size evaluation of DCIS.

Ductal Carcinoma In Situ (DCIS) Diagnosed by MRI-Guided Biopsy among BRCA1/BRCA2 Mutation Carriers.

While BRCA1/BRCA2 pathogenic sequence variants (PSVs) clearly confer an increased risk for invasive breast cancer, the extent to which these mutant alleles increase DCIS risk is less clear. To assess the rate of detection over a 5-year period, and MRI imaging features of pure noncalcified DCIS in a cohort of Israeli BRCA1/BRCA2 PSV carriers attending a high-risk clinic from 2015 to 2020. All female BRCA1/BRCA2 PSV-carriers followed at the Meirav High-risk clinic from 2015 to 2020 were eligible if they underwent semiannual breast imaging (MRI/mammography) and MRI-guided biopsy-proven pure DCIS. Clinical data, pathology information, and imaging characteristics were retrieved from the computerized archiving system. 18/121 (15.2%) participating BRCA1 PSV carriers and 8/81 (10.1%) BRCA2 PSV-carriers who underwent MRI-guided biopsy were diagnosed with DCIS. The median age of BRCA1 carriers and BRCA2 carriers was 49.8 years and 60.6 years, respectively (p = 0.55). Negative estrogen-receptor tumors were diagnosed in 13/18 (72%) BRCA1 and 2/8 (25%) BRCA2 PSV carriers (p < 0.05). Thirteen (13/18-72%) BRCA1 carriers had intermediate to high-grade or high-grade DCIS compared with 4/8 (50%) of BRCA2 carriers (p = 0.03). Over the 5-year study period, 29/1100 (2.6%) BRCA1/BRCA2 PSV carriers were diagnosed with DCIS seen on MRI only. MRI-detected noncalcified DCIS is more frequent in BRCA1 PSV carriers compared with BRCA2 carriers, unlike the BRCA2 predominance in mammography-detected calcified DCIS. BRCA1-related DCIS is diagnosed earlier, more likely to be estrogen receptor-negative and of higher grade compared with BRCA2-related DCIS. Future prospective studies should validate these results and assess the actual impact they might have on clinical management of BRCA PSV carriers.

Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade?

The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma in situ (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 in situ (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) vs 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.

Imaging of Noncalcified Ductal Carcinoma In Situ.

Ductal carcinoma in situ (DCIS) is a commonly encountered malignancy, accounting for approximately 20% of new breast cancer diagnoses in the United States. DCIS is characterized by a proliferation of tumor cells within the terminal duct lobular unit with preservation of the basement membrane. Typically nonpalpable and asymptomatic, DCIS is most often detected as calcifications on screening mammography. However, DCIS may also be noncalcified. When compared to calcified DCIS, noncalcified DCIS is more likely to be symptomatic, with patients most often presenting with nipple discharge or a palpable mass. Diagnosing noncalcified DCIS is challenging since it may be occult or subtle on mammography, and ultrasound findings can be nonspecific and may be interpreted as benign fibrocystic changes. In cases with a calcified component of DCIS, the extent of DCIS may be underestimated by mammography because not all involved areas may calcify. Breast magnetic resonance imaging (MRI), although less readily available than mammography and ultrasound, is advantageous in detecting noncalcified DCIS, especially high grade DCIS, which may not develop microcalcifications. MRI relies on abnormal contrast uptake due to tumor vascularity and changes in vessel density and permeability. This pictoral review presents the spectrum of imaging findings of noncalcified DCIS to assist radiologists in accurately detecting and describing its key imaging findings. Utilizing different modalities, we review the differential diagnoses for noncalcified DCIS, show illustrative cases of noncalcified DCIS, and discuss the importance of this entity.

Noncalcified Ductal Carcinoma In Situ (DCIS): Rate and Predictors of Upgrade to Invasive Carcinoma

To determine the upgrade rate of noncalcified ductal carcinoma in situ (DCIS) and features that are associated with risk of upgrade to invasive disease at surgery. A retrospective review was conducted of consecutive women who were diagnosed with noncalcified DCIS from January 2007 to December 2016. Patient demographics, imaging findings, biopsy pathology results, and surgical outcomes were reviewed. The unpaired t test, chi-square test, and Fisher's exact test were used to compare features between the cases of DCIS that did and did not upgrade to invasive carcinoma at surgery. Over a 10-year period, 78 women (mean age 62 years, range 30-88 years) were diagnosed with noncalcified DCIS. Two-thirds (67.9%, 53/78) of cases were detected on screening mammography, and 15.4% (12/78) of diagnoses were made after presentation with an area of palpable concern. The most common mammographic presentations of noncalcified DCIS were mass (51.3%, 40/78) and asymmetry (30.8%, 24/78). Seventeen cases (21.8%, 17/78) were upgraded to invasive ductal carcinoma (IDC) at surgery. Features associated with upgrade risk included older patient age (68.1 versus 60.3 years, OR 1.08, p < 0.01) and family history of breast cancer in a first-degree relative (41.2% [7/17] versus 16.4% [10/61], OR 3.57, p = 0.03). In our study cohort, the upgrade rate of noncalcified DCIS to IDC at surgery is 21.8%. Upgrade risk is associated with older patient age and family history of breast cancer in a first-degree relative.

Differentiation between Clinically Noninflammatory Granulomatous Lobular Mastitis and Noncalcified Ductal Carcinoma in situ Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Introduction: Challenges in differentiation between clinically noninflammatory granulomatous lobular mastitis (GLM) and noncalcified ductal carcinoma in situ (DCIS) remain. Objective: To identify the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics contributing to their differential diagnosis. Methods: A total of 33 clinically noninflammatory GLM and 36 noncalcified DCIS were retrospectively analyzed in the study. Internal enhancement of a nonmass enhancement (NME) lesion was divided into clustered enhanced ring (absence/presence), and clustered enhanced ring (presence) was further classified as small and large ring based on the optimal cutoff value. The 5th Breast Imaging and Data System MRI descriptors were used for assessing the other DCE-MRI characteristics. Multivariate analysis including variables with significant differences in univariate analyses was conducted to identify the independent predictors. The discriminative abilities of different predictors and their combination were compared by area under the receiver-operating characteristic curves (AUCs). Results: An NME lesion was seen more commonly in clinically noninflammatory GLM than in noncalcified DCIS (p = 0.003). DCE-MRI characteristics with significant differences in univariate analyses included NME size, clustered enhanced ring (absence/presence), ring size, initial increase and kinetic characteristics for the differentiation between these two entities presenting as NME lesion. Clustered enhanced ring (presence) was further classified as small (≤7 mm) or large ring (>7 mm). Multivariate analysis revealed that internal enhancement and initial increase were identified as significant independent predictors, and the AUC of their combination achieved the highest value of 0.867 (95% CI, 0.748–0.943). Conclusions: An NME lesion with a large ring is more highly suggestive of clinically noninflammatory GLM.

Comparison of diagnostic accuracy of digital breast tomosynthesis, digital mammography, and ultrasonography for the non-calcified ductal carcinoma in situ of the breast

Objective To compare the diagnostic value of digital breast tomosynthesis (DBT), digital mammography (DM), and ultrasonography (US) for the non-calcified ductal carcinoma in situ (DCIS) of the breast. Methods To retrospectively analyze the imaging and clinical data of ductal carcinoma in situ which was confirmed by surgical pathology and displayed as non-calcified lesions in mammography in 110 patients. DBT, DM and US were performed in all the 110 cases. The breast imaging report and data system (BI-RADS) classification and breast density classification were evaluated using the 5th edition of BI-RADS. In our study, BI-RADS 4B, 4C, and 5 were regarded to be in agreement with the pathologic findings, BI-RADS 1, 2, 3, and 4A were considered to be negative. BI-RADS c and d were classified as dense breasts, BI-RADS a and b were classified as fatty breasts. The imaging findings of the non-calcified ductal carcinoma in situ were evaluated. The differences in the detection rate and the diagnostic accuracy among the DBT, DM and US in all cases and in different breast density were compared using χ2 test. Results The detection rates of DBT, DM, and US for non-calcified DCIS in all cases were 84.5% (93/110), 70.9% (78/110), 95.5%(105/110). Pairwise comparisons among the three techniques showed statistically significant difference (P 0.05). By DBT and DM, most cases of non-calcified DCIS presented as a mass lesion with an irregular shape, indistinct margin, and isodense composition. Conclusion US is more advantageous to the detection of the non-calcified DCIS and the non-calcified DCIS in the dense breast. Key words: Breast neoplasms; Mammography; Comparative study; Tomosynthesis

MR imaging appearance of noncalcified and calcified DCIS.

To evaluate the MR appearance of noncalcified ductal carcinoma insitu (DCIS), with comparison to calcified DCIS. A retrospective, IRB-approved review of all DCIS diagnosed via MR biopsy between 2007 and 2011 was performed. DCIS was categorized as noncalcified based on the absence of calcifications on mammography and specimen radiography. MR morphology (focus, mass, nonmass enhancement [NME]) and enhancement kinetics (initial and delayed) for noncalcified DCIS were recorded and compared based on nuclear grade (1-3), size (<1.5cm, 1.5-5cm, >5cm), and presence of necrosis. Imaging features of noncalcified and calcified DCIS were also compared. 115 cases of MR biopsy-proven DCIS were identified: 65 (56%) noncalcified and 50 (44%) calcified. For noncalcified DCIS, NME morphology was more common than mass or focus (60% vs 30.8% and 9.2%). There was a significant association between morphology and enhancement kinetics, with NME more likely demonstrating medium and persistent kinetics, and foci or masses demonstrating rapid and plateau or washout kinetics (P<.05). There was also a significant association between morphology and nuclear grade, with NME more likely seen with grade 3 DCIS (P=.024), and between size and initial enhancement, with lesions <1.5cm more likely to have rapid initial enhancement (P=.0036). No significant difference was identified between calcified and noncalcified DCIS in terms of morphology, enhancement characteristics, nuclear grade, or presence of necrosis. The MR appearance of noncalcified DCIS closely mirrors that of calcified DCIS. Recognizing these imaging features may allow for improved identification of this MRI-detected abnormality, even in the absence of calcifications.

Abstract P4-01-02: Diagnostic value of breast specific gamma imaging for breast cancer

Abstract In this study, 422 female patients who presented with clinical indications and underwent ultrasound (US), mammography (MMG), and breast specific gamma imaging (BSGI) before surgery during the period from July 2013 to June 2015 were retrospectively reviewed. Twenty-two of the patients had no pathological report available and were excluded. These patients who presented with clinical indications underwent both ultrasound and mammographic examinations initially. If both US and MMG were positive, the patient was recommended for a BSGI examination for pre-surgical planning. A BSGI examination was also recommended for patients with negative or indeterminate mammographic findings. The diagnostic results were compared with histological examination and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each modality were determined. Combinations of either two or three of the diagnostic results were also reviewed and the corresponding diagnostic indicators calculated. For these combinations, a positive indication on one of the two (or three) diagnostic tests were interpreted as a positive result. The sensitivity of US, MMG, BSGI, the combination of US and MMG, US and BSGI, MMG and BSGI, and the combination of all three together in the diagnosis of breast carcinoma were determined for the 400 patients included in the study and are listed in Table 1, column 1. The specificity, PPV, and NPV for each of these modalities and combinations of modalities were also determined and are shown Table 1, column 2-4. Table 1 SensitivitySpecificityPPVNPVUS61.389.289.759.8MMG67.594.394.765.2BSGI83.187.991.477.1US &amp; MMG86.884.789.880.6US &amp; BSGI91.382.889.186.1MMG &amp; BSGI92.283.489.585.6US &amp; MMG &amp; BSGI97.579.087.895.4 The population was comprised of 243 patients with 245 malignant lesions and 157 patients with 189 benign lesions. The malignant lesions were primarily infiltrating ductal carcinoma (76%) and ductal carcinoma in situ (14%), with the remaining lesions (10%) being invasive lobular carcinoma, Paget's disease and mixed carcinomas. The benign lesions were primarily fibroadenoma (39%), adenosis (40%) and papilloma (10%), with the remaining lesions (11%) being duct ectasia, inflammation or phyllodes. There were 79 false negative cases by MMG, however, when ultrasound and BSGI were combined, 73 out of 79 were accurately identified. Additionally, there were nine, seventeen and eighteen Ductal Carcinoma in situ (DCIS) misdiagnosed by BSGI, MMG, and ultrasound respectively, but through joint imaging of BSGI+MMG+US; 33 out of 35 were accurately judged. BSGI is a useful adjunct modality for the diagnosis of breast carcinoma. It is also extremely useful for diagnosis of non-calcified DCIS, and circumvents limitations of mammography in identifying malignant lesion in dense breast. Moreover, it is helpful for improving the diagnosis accuracy of breast carcinoma when BSGI is combined together with MMG and US. Citation Format: Mallik DK, Zhang H, Shi H, Tan H, Shen L, Hu G, Hu H, Sejdinaj F, Pang Y, Zhu W, Yang W. Diagnostic value of breast specific gamma imaging for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-01-02.

Calcified and Non-Calcified Ductal Carcinoma &amp;lt;i&amp;gt;in Situ&amp;lt;/i&amp;gt;: Contrast-Enhanced MRI Features and Pathological Correlation

Background: Early detection of ductal carcinoma in situ (DCIS) is essential for improving the prognosis of breast cancer. Among mammographically detected DCIS cases, approximately 10% - 20% of DCIS cases are manifested as non-calcified. Purpose: To evaluate differences in MRI findings and histological features between mammographically evident non-calcified and calcified DCIS. Material and Methods: This study included 84 cases of pathologically proven DCIS in 82 patients who underwent preoperative breast MRI. The lesions were divided into non-calcified and calcified DCIS according to the presence of calcifications on mammography. MRI features were analyzed according to the enhancement pattern. The pathologic features were also reviewed. Results: Among the 84 DCIS cases, 30 (36%) were classified as non-calcified DCIS, and 54 (64%) as calcified DCIS on mammography. On MRI, 27% (8/30) of non-calcified DCIS and 17% (9/54) calcified DCIS presented as mass enhancement, 73% (22/30) non-calcified DCIS and 83% (45/54) calcified DCIS presented as non-mass enhancements. No significant difference in the type of lesion was observed between non-calcified and calcified DCIS (p = 0.274). Histopathologically, high nuclear grade, presence of necrosis, and presence of HER-2 status were more common in calcified DCIS than in non-calcified DCIS (p < 0.05). Conclusion: There were no significant differences in MRI findings between non-calcified and calcified DCIS. However, calcified DCIS had more aggressive histological features than non-calcified DCIS.

Comparison of Ultrasound and MR Imaging of Non-Calcified Ductal Carcinoma in Situ with Pathologic Correlation

To illustrate the imaging features of non-calcified ductal carcinoma in situ (DCIS) on ultrasonography and breast MR imaging and to determine the role the imaging studies in the diagnosis and treatment decision of non-calcified DCIS. Radiologic images and clinical histories of 34 patients with histologically verified non calcified ductal carcinoma in situ (DCIS) were retrospectively studied. All patients were female and between the ages of 27 and 73 years (mean age, 47.6 years). Mammography (n=34), Breast US (n=34), and Breast MR imaging (n=29) were performed. The diagnosis of DCIS of the breast was pathologically confirmed by means of examination of the specimens obtained at surgical biopsy. We correlated radiologic findings with pathologic results. All patients were female and between the ages of 27 and 73 years(mean age, 47.6 years). The mean size was 1.7cm. DCIS is a heterogeneous disease comprising a spectrum of noninvasive malignant tumors of the breast. In the 34 patients who underwent ultrasound, 32 patients presented with abnormal findings: mass(63%), intraductal echogenic lesion(18%), irregular ductal wall thickening or nodularity(15%) and mixed pattern(4%). In the 29 patients who had received breast MRI, a mass was present in 22 patients and irregular ductal enhancement in 7 patients. Diagnosis of non-calcified DCIS by mammography is challenging. Thus, high resolution US and breast MRI can be essential to decide accurate diagnosis. Comprehensive knowledge of US and MRI findings of non-calcified DCIS of the breast can help early detection and improve prognosis.

Calcified and non-calcified ductal carcinoma in situ: differences in sonographic and pathologic features

Objective To compare the sonographic and pathologic features of calcified and non-calcified ductal carcinoma in situ(DCIS). Methods A total of 83 lesions in 82 consecutive patients with pathologically confirmed pure DCIS were recruited. One patient had bilateral lesions. All lesions were divided into calcified DCIS and non-calcified DCIS according to the presence of calcifications on mammography. Their sonographic features and pathologic reports for all patients with DCIS were retrospectively reviewed. Statistical comparisons were performed using the chi-square test. Results (1)Calcified DCIS showed positive ultrasound(US) findings in 80% (44/55)of cases. The most common US finding was nonmass lesions (43.6%, 24/55). Nine cases had pure ductal dilatations(16.4%, 9/55). Non-calcified DCIS showed positive US findings in 96.4% (27/28)of cases.The most common US finding was mass (89.2%, 25/28). Two cases had pure ductal dilatations(7.1%, 2/28). No significant difference was found in the shape, margin, orientation, posterior feature of a mass between the calcified and non-calcified groups (P>0.05). Significant difference was observed in the size, boundary, echogenicity on ultrasound of the two groups (P<0.05). (2)At histopathology, the pathological scores high nuclear grade, positive ER status, positive PR status, positive Ki67 status and the presence of Her-2/neu oncogene were more common in the calcified group than in the non-calcified group. Conclusions Calcified and non-calcified pure DCIS have different pathologic and sonographic features. Calcified DCIS has more aggressive histological features than non-calcified DCIS. Key words: Ultrasonography; Breast neoplasms; Calcification

The diagnostic sensitivity of dynamic contrast-enhanced magnetic resonance imaging and breast-specific gamma imaging in women with calcified and non-calcified DCIS

Early detection of breast cancer reduces mortality. Therefore, diagnosis of ductal carcinoma in situ (DCIS) is important. To compare the sensitivities of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and breast-specific gamma imaging (BSGI) in pathologically proven calcified and non-calcified DCIS. Thirty-five patients with pathologically diagnosed DCIS from 1 June 2009 through 31 December 2011, underwent a protocol involving both breast MRI and BSGI. Each image was assessed by a separate dedicated breast radiologist. All lesions were divided into two groups; with or without microcalcifications on mammograms. In cases without microcalcifications, we recorded the mass, asymmetry, or negative findings on mammography. On MRI, the enhancement pattern was categorized as mass or non-mass-like enhancement. On BSGI, the uptake pattern was analyzed. The histopathological features of the lesions were obtained. Statistical analysis of the sensitivity of each modality was performed using McNemar's test. Thirty-five women with a mean age of 48 years (range, 26-69 years) were enrolled in the study. The total sensitivities of MRI and BSGI in the 35 cases were 91.4% (32 of 35 DCIS) and 68.6% (24 of 35 DCIS), respectively. Eighteen cases with DCIS displayed microcalcifications on mammography, while 17 cases did not. Of these 17 cases without microcalcifications on mammography, 88.2% (15 of 17 DCIS) were detected by MRI and 52.9% (9 of 17 DCIS) by BSGI. Of 18 cases with microcalcifications on mammography, 94.4% (17 of 18 DCIS) were detected by MRI and 83.3% (15 of 19 DCIS) by BSGI. MRI showed a higher sensitivity for the detection of calcified and non-calcified DCIS and is more helpful than BSGI in cases without microcalcifications on mammography.

Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status

The clinicopathologic, mammographic, and sonographic findings in patients with pure ductal carcinoma in situ (DCIS) were assessed by estrogen receptor (ER) expression. After institutional review board approval, patients with pure DCIS evaluated from January 1996 to July 2009 with known ER status and available imaging were identified. Images were reviewed as per the ACR BI-RADS(®) lexicon (4th edition). Clinical, pathologic, and imaging characteristics were analyzed by ER status using t test, Chi square test, and Fisher's exact test. Of 1,219 patients with pure DCIS and known ER status identified, 1,187 with complete data were included. Mammography was performed in all 1,187 patients and sonography in 519 (44 %). There were 972 (82 %) patients with ER-positive and 215 (18 %) with ER-negative disease. ER-negative DCIS was more likely to be high grade (93 vs 44 %, p < 0.0001), associated with comedonecrosis (64 vs 29 %, p < 0.0001), and multifocal (23 vs 15 %, p = 0.009). On sonography, ER-negative DCIS was more likely to be visible (61 vs 46 %, p = 0.004), larger (mean size, 2.3 vs 1.6 cm, p = 0.006), and show posterior shadowing (53 vs 28 %, p = 0.006). Mastectomy was more frequently performed for ER-negative DCIS (47 vs 37 %, p = 0.008). Palpable DCIS was visible on sonography in 55 % of cases and mammography in 81 %. Compared with ER-positive palpable DCIS, ER-negative palpable DCIS was larger and more likely to be visible on sonography. Compared with ER-positive noncalcified DCIS, ER-negative noncalcified DCIS was less likely to be visible on mammography. ER-positive and ER-negative pure DCIS have different clinicopathologic and imaging characteristics. ER-negative DCIS is associated with worse prognostic factors than ER-positive DCIS. On sonography, ER-negative DCIS is more frequently visible than ER-positive DCIS, tends to be larger, and more frequently demonstrates posterior shadowing.

US Appearance of Ductal Carcinoma in Situ

Ductal carcinoma in situ (DCIS) is a noninvasive cancer that accounts for 25% of all breast cancers diagnosed in the United States. DCIS is a heterogeneous disease process with varied clinical manifestations and a broad spectrum of imaging findings. With advances in technology, the ability to detect early-stage cancers has improved, and understanding the role of ultrasonography (US) in the multimodality era of detection and diagnosis is paramount. When calcifications are identified at mammography, US can be performed to evaluate for an invasive component and to allow possible US-guided biopsy. Use of high-frequency transducers, spectral compounding, and speckle reduction algorithms can aid in the detection of calcifications. Calcified DCIS most commonly manifests as echogenic foci located within a mass or duct, associated with internal microlobulations, or distributed in a branch pattern. Noncalcified DCIS, which is more often identified in symptomatic patients, may manifest as a hypoechoic mass with microlobulated margins and no posterior acoustic features, or it may have a "pseudomicrocystic" appearance. Harmonic imaging and coronal reconstruction may improve detection of noncalcified DCIS. The appearance of DCIS at "second-look" US can be subtle and may warrant a lower threshold for detection, given a higher pretest probability of malignancy. US features are nonspecific, and careful correlation with respect to lesion location, size, shape, and depth is needed. The presence of internal vascularity can help increase the positive predictive value of US in this setting. US is a useful adjunct to mammography and magnetic resonance imaging, and recognizing the US appearance of DCIS will aid in the detection and diagnosis of this disease entity.

Screening-detected calcified and non-calcified ductal carcinoma in situ: Differences in the imaging and histopathological features

To compare the imaging and histopathological features of screening-detected calcified and non-calcified ductal carcinoma in situ (DCIS). The study involved 217 DCIS cases in 212 asymptomatic patients admitted between May 2007 and December 2010. All lesions were divided into calcified and non-calcified DCIS according to the presence of calcifications on mammography. Two radiologists reviewed the findings from mammography, ultrasound, and magnetic resonance imaging (MRI) in consensus according to the Breast Imaging Reporting and Data System. The histopathological features of the lesions were obtained from medical records. Statistical comparisons were performed using the chi-square, Fisher's exact test, and intraclass correlation coefficient (ICC) analyses. On mammography, most non-calcified DCIS presented as either a false-negative finding (49%) or mass lesion (30%), whereas most calcified DCIS (68.5%) presented as calcification alone (p<0.001). At ultrasound, all of the non-calcified DCIS appeared as a mass, whereas 62% of the calcified DCIS appeared as a mass (p<0.001). At histopathology, high nuclear grade (p=0.017), necrosis (p<0.001), positive progesterone receptor (p=0.027), and presence of the HER-2/neu oncogene (p<0.001) were more common in the calcified DCIS than in the non-calcified DCIS. There were no significant differences in the MRI features between the two groups. The ICC values of the non-calcified and calcified DCIS between predicted tumour size and pathologic size were 0.625 versus 0.705 for mammography, 0.801 versus 0.552 for ultrasound, and 0.760 versus 0.767 for MRI. Screening-detected calcified and non-calcified DCIS have different mammographic and sonographic features. Ultrasound could be helpful to predict the pathological size of the non-calcified DCIS.

Cryosurgery of breast cancer.

With recent improvements in breast imaging, the ability to identify small breast tumors is markedly improved, prompting significant interest in the use of cryoablation without surgical excision to treat early-stage breast cancer. The cryoablation is often performed using ultrasound-guided tabletop argon-gas-based cryoablation system with a double freeze/thaw cycle. Recent studies have demonstrated that, as a primary therapy for small breast cancer, cryoablation is safe and effective with durable results, and can successfully destroy all cancers <1.0 cm and tumors between 1.0 and 1.5 cm without a significant ductal carcinoma-in-situ (DCIS) component. Presence of noncalcified DCIS is the cause of most cryoablation failures. At this time, cryoablation should be limited to patients with invasive ductal carcinoma <1.5 cm and with <25% DCIS in the core biopsy. For unresectable advanced breast cancer, cryoablation is a palliation modality and may be used as complementary for subsequent resection or other therapies.

Noncalcified Ductal Carcinoma In Situ

The purpose of this study was to evaluate imaging findings in noncalcified ductal carcinoma in situ (DCIS) and to compare histologic findings between noncalcified and calcified DCIS. From January 2005 to May 2008, 195 patients with pathologically confirmed DCIS were recruited. Among these, 36 patients (18%) had noncalcified DCIS. We retrospectively reviewed their imaging findings according to the American College of Radiology Breast Imaging Reporting and Data System. We also reviewed pathologic reports for all patients with DCIS to obtain information on the histologic type, nuclear grade, and biological markers. Among the 36 patients with noncalcified DCIS, 21 (58%) were symptomatic. On mammography, 25 patients (69%) showed abnormal findings, and 11 patients showed false-negative findings. On sonography, 29 of 36 patients (81%) showed a mass, whereas the remaining 7 patients (19%) showed nonmass lesions. The sonographic findings for the masses were variable: 25 of 29 masses (86%) were irregular in shape; 14 of 29 (48%) showed indistinct margins; and 9 (31%) were angular or spiculated. The orientation of the mass was not parallel in 6 of 29 cases (21%). Two of 29 masses (7%) showed an echogenic halo at the lesion boundary. Noncalcified DCIS tended to have a nonhigh nuclear grade and was frequently the noncomedo type. In addition, c-erb-B2 was more commonly expressed in calcified DCIS. Imaging findings for noncalcified DCIS are relatively nonspecific and are frequently similar to those of invasive malignancy. This knowledge may be useful for detecting noncalcified DCIS, planning treatment, and predicting the prognosis.

Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients

To present the sonographic findings of mammographically non-calcified ductal carcinoma in situ (DCIS) with histopathologic correlation. The mammographic and ultrasonographic presentations of 47 radiographically non-calcified DCIS lesions in 35 patients were retrospectively analysed. Histological characteristics (architectural appearance, nuclear grade, percent of involved lobules, and presence of necrosis) were reviewed. Seventeen lesions were not mammographically visible (17/47, 36%). Ultrasonographically, these lesions showed an irregular shape (28/47, 60%), microlobulated margins (34/47, 72%) and abrupt interfaces (42/47, 90%). Only 11% (5/47) displayed posterior shadowing. The echotexture of these lesions was most frequently complex (29/47, 62%); therefore, they were divided into two types: type I (24 cases), which were predominantly solid with cystic components, and type II (five cases), which were predominantly cystic with a solid intra-cystic component. A trend to have greater than 50% DCIS cells in cancerous lobules was observed in masses displaying type I echotexture (difference=36%, 95% confidence interval 10.6-62.5) and microlobulated margins (difference=32%, 95% confidence interval 5.1-58.7). Ultrasonographically detected radiographically non-calcified DCIS commonly displays an irregular shape, microlobulated margins, and complex echotexture, giving a "pseudomicrocystic" appearance. Microlobulated margins and "pseudomicrocystic" echotexture seem to be associated with a cancerization of the lobules.

Non-Calcified Ductal Carcinoma in Situ: Ultrasound and Mammographic Findings Correlated with Histological Findings

PurposeTo evaluate radiological findings of non-calcified ductal carcinoma in situ (DCIS) and to correlate those with histological features.Materials and MethodsFrom July 2002 to March 2006, 22 patients with histologically-proven non-calcified DCIS were included. Mammography was obtained in 19 patients, ultrasound in 18 patients, and both examinations in 15 patients. Radiological findings were evaluated according to the Breast Imaging Reporting and Data System by American College of Radiology. Histological tumor subtype and Van Nuys classification of DCIS were assessed.ResultsHistological subtypes consisted of mixed type in 11 patients (50%), comedo in 4 (18%), cribriform in 4 (18%), papillary type in 2 (9%), and solid in one (5%). According to Van Nuys classification, group 3 DCIS was observed in 13 (59%) patients. In the 19 patients who underwent mammography, 13 patients presented with abnormal findings: focal asymmetry in 7 patients (37%), masses in 4 (21%), skin thickening in one (5%), and architectural distortion in one (5%). In the 18 patients who had received breast ultrasound, a mass was present in 15 (83%) patients and ductal changes in 3 patients (17%). Sixty percent of patients with masses on ultrasound had group 3 DCIS and 100% of patients with ductal change had group 1 DCIS (p = 0.017).ConclusionDiagnosis of non-calcified DCIS by mammography is not an easy task due to the lack of typical malignant calcifications or masses. High resolution ultrasound can be useful for detecting non-calcified DCIS, and ultrasound findings are correlated with histological features.