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Komarla R, Gilliland L, Piraner M, Seidel R, Clifford K, Kunjummen J. Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade? Br J Radiol 2022; 95:20211013. [PMID: 34870448 PMCID: PMC8822564 DOI: 10.1259/bjr.20211013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSION 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. ADVANCES IN KNOWLEDGE Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.
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Affiliation(s)
- Rohini Komarla
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lawrence Gilliland
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Maria Piraner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca Seidel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kelly Clifford
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jean Kunjummen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Green L. Radiogenomics and DCIS: Can the Mammographic Appearance of Microcalcifications Tell us More Than Just the Likelihood of Malignancy? Acad Radiol 2021; 28:969-971. [PMID: 33451900 DOI: 10.1016/j.acra.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/01/2023]
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Avdan Aslan A, Gültekin S, Esendağli Yilmaz G, Kurukahvecioğlu O. Is There Any Association Between Mammographic Features of Microcalcifications and Breast Cancer Subtypes in Ductal Carcinoma In Situ? Acad Radiol 2021; 28:963-968. [PMID: 32620528 DOI: 10.1016/j.acra.2020.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES To analyze the association between mammographic features of microcalcifications and histopathological prognostic factors based on estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2/neu) in ductal carcinoma in situ (DCIS). MATERIALS AND METHODS We retrospectively determined 66 patients with microcalcification-associated pure DCIS. Distribution and morphological features of the microcalcifications were described using Breast Imaging Reporting and Data System lexicon. All patients were divided into three subgroups: ER-positive, HER-2 positive, and triple-negative according to the immunohistochemical findings. RESULTS The morphological features of microcalcifications and receptor subtypes were significantly correlated (p = 0.026). Fine pleomorphic and fine linear branching microcalcifications were observed in 85.2% of HER-2 positive cases, whereas this ratio was 71.4 % in ER-positive and 25% in the triple-negative group. Fine linear branching microcalcifications with linear or segmental distribution were more frequently found with comedo necrosis (p < 0.05). Larger tumour sizes were also associated with microcalcification distribution (p < 0.001). Segmental microcalcifications more likely associated with larger tumour sizes. CONCLUSION Mammographic features in DCIS correlated with immunohistochemical and histopathological prognostic factors.
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Choe J, Chikarmane SA, Giess CS. Nonmass Findings at Breast US: Definition, Classifications, and Differential Diagnosis. Radiographics 2021; 40:326-335. [PMID: 32125954 DOI: 10.1148/rg.2020190125] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A nonmass finding at US has been described as a discrete identifiable area of altered echotexture compared with that of the surrounding breast tissue that does not conform to a mass shape. Recognizing nonmass findings is important because breast cancer can manifest as such lesions, and US correlate findings for mammographic and breast MRI abnormalities may manifest as nonmass findings. The term nonmass finding is not part of the current Breast Imaging Reporting and Data System US terminology, and no standardized approach to classify and evaluate nonmass findings at US currently exists, despite the various classification systems proposed in the literature. There is also considerable overlap between the sonographic features of benign and malignant causes of nonmass findings. These limitations cause diagnostic difficulty in evaluating clinical significance and recommending appropriate management. The authors review the definitions and classification systems of US nonmass findings proposed in the literature and illustrate the sonographic features of nonmass findings to help radiologists identify them at US. A range of benign and malignant causes of nonmass findings are reviewed, and sonographic-histopathologic correlations of nonmass findings are discussed. Cases of breast MRI and mammographic findings that may manifest as US nonmass findings are presented. Radiologists can improve detection and interpretative accuracy, as well as correlation of mammographic and MRI breast lesions, by increasing their recognition and understanding of nonmass findings at US.©RSNA, 2020.
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Affiliation(s)
- Jihee Choe
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Sona A Chikarmane
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Catherine S Giess
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
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Noncalcified Ductal Carcinoma In Situ (DCIS): Rate and Predictors of Upgrade to Invasive Carcinoma. Acad Radiol 2021; 28:e71-e76. [PMID: 32222328 DOI: 10.1016/j.acra.2020.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Xiao H, Chen J, Duan L, Li S. Role of emerging vitamin K‑dependent proteins: Growth arrest‑specific protein 6, Gla‑rich protein and periostin (Review). Int J Mol Med 2021; 47:2. [PMID: 33448308 PMCID: PMC7834955 DOI: 10.3892/ijmm.2020.4835] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/21/2020] [Indexed: 01/27/2023] Open
Abstract
Vitamin K‑dependent proteins (VKDPs) are a group of proteins that need vitamin K to conduct carboxylation. Thus far, scholars have identified a total of 17 VKDPs in the human body. In this review, we summarize three important emerging VKDPs: Growth arrest‑specific protein 6 (Gas 6), Gla‑rich protein (GRP) and periostin in terms of their functions in physiological and pathological conditions. As examples, carboxylated Gas 6 and GRP effectively protect blood vessels from calcification, Gas 6 protects from acute kidney injury and is involved in chronic kidney disease, GRP contributes to bone homeostasis and delays the progression of osteoarthritis, and periostin is involved in all phases of fracture healing and assists myocardial regeneration in the early stages of myocardial infarction. However, periostin participates in the progression of cardiac fibrosis, idiopathic pulmonary fibrosis and airway remodeling of asthma. In addition, we discuss the relationship between vitamin K, VKDPs and cancer, and particularly the carboxylation state of VKDPs in cancer.
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Affiliation(s)
- Huiyu Xiao
- Department of Physiology, Dalian Medical University, Dalian, Liaoning 116044
| | - Jiepeng Chen
- Sungen Bioscience Co., Ltd., Shantou, Guangdong 515071, P.R. China
| | - Lili Duan
- Sungen Bioscience Co., Ltd., Shantou, Guangdong 515071, P.R. China
| | - Shuzhuang Li
- Department of Physiology, Dalian Medical University, Dalian, Liaoning 116044
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Qu N, Luo Y, Yu T. Differentiation between Clinically Noninflammatory Granulomatous Lobular Mastitis and Noncalcified Ductal Carcinoma in situ Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Breast Care (Basel) 2020; 15:619-627. [DOI: 10.1159/000506068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Challenges in differentiation between clinically noninflammatory granulomatous lobular mastitis (GLM) and noncalcified ductal carcinoma in situ (DCIS) remain. <b><i>Objective:</i></b> To identify the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics contributing to their differential diagnosis. <b><i>Methods:</i></b> 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). <b><i>Results:</i></b> An NME lesion was seen more commonly in clinically noninflammatory GLM than in noncalcified DCIS (<i>p</i> = 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). <b><i>Conclusions:</i></b> An NME lesion with a large ring is more highly suggestive of clinically noninflammatory GLM.
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Tajima CC, de Sousa LLC, Venys GL, Guatelli CS, Bitencourt AGV, Marques EF. Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ. Radiol Bras 2019; 52:43-47. [PMID: 30804615 PMCID: PMC6383537 DOI: 10.1590/0100-3984.2018.0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) is a precursor mammary lesion whose malignant
cells do not extend beyond the basement membrane and presents a risk of
progression to malignant disease. Its early detection increased with screening
mammography. The objective of this study was to review the literature on the
main presentations of DCIS on magnetic resonance imaging (MRI), through searches
of the Medline/PubMed, Latin-American and Caribbean Center on Health Sciences
Information (Lilacs), and Scientific Electronic Library Online (SciELO)
databases. DCIS can occur in its pure form or in conjunction with invasive
disease, in the same lesion, in different foci, or in the contralateral breast.
MRI has a high sensitivity for the detection of pure DCIS, being able to
identify the non-calcified component, and its accuracy increases with the
nuclear grade of the lesion. The most common pattern of presentation is
non-nodular enhancement; heterogeneous internal structures; a kinetic curve
showing washout or plateau enhancement; segmental distribution; and restricted
diffusion. MRI plays an important role in the detection of DCIS, especially in
the evaluation of its extent, contributing to more reliable surgical excision
and reducing local recurrence.
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Scott-Moncrieff A, Sullivan ME, Mendelson EB, Wang L. MR imaging appearance of noncalcified and calcified DCIS. Breast J 2017; 24:343-349. [DOI: 10.1111/tbj.12948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Megan E. Sullivan
- Department of Pathology; Northwestern Memorial Hospital; Chicago IL USA
| | | | - Lilian Wang
- Department of Radiology; Northwestern Memorial Hospital; Chicago IL USA
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Cha H, Chang YW, Lee EJ, Hwang JY, Kim HJ, Lee EH, Ryu JK. Ultrasonographic features of pure ductal carcinoma in situ of the breast: correlations with pathologic features and biological markers. Ultrasonography 2017; 37:307-314. [PMID: 29169230 PMCID: PMC6177689 DOI: 10.14366/usg.17039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/13/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic features of pure ductal carcinoma in situ (DCIS) of the breast and to evaluate the correlations of ultrasonographic features with pathologic and biological features. Methods A total of 141 lesions in 138 women with pure DCIS who underwent preoperative breast ultrasonography were retrospectively reviewed. Ultrasonographic features were analyzed using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon and the diagnostic criteria of the Japan Society of Ultrasonics in Medicine. Pathologic features including the nuclear grade and presence of comedonecrosis were evaluated. Biological markers including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, as well as the Ki-67 index, were recorded. Ultrasonographic features were compared with pathologic findings and biological markers using the chi-square test. P-values of <0.05 were considered to indicate statistical significance. Results Of the 141 lesions, 75 (53.2%) were mass lesions, 56 (39.7%) were non-mass lesions, and 10 (7.1%) were not visible. The most common feature of the mass pattern was a mass with irregular shape (32.6%), an indistinct margin (27.7%), and hypoechogenicity (37.6%). Microcalcifications were observed in 48 cases (36.6%) as an associated feature. Calcifications outside of a mass were more common than calcifications within a mass. Ultrasonographic microcalcifications and ductal changes were frequently observed in non-mass lesions. Ultrasonographic non-mass lesions were associated with high-grade DCIS (P=0.004) and the presence of comedonecrosis (P=0.006). Microcalcifications were significantly associated with high-grade DCIS (P<0.001), the presence of comedonecrosis (P<0.001), an elevated Ki-67 (P<0.001), and HER2 positivity (P=0.003). Conclusion The most common ultrasonographic feature of pure DCIS was an irregular, hypoechoic mass with an indistinct margin. Ultrasonographic microcalcifications and ductal changes were more frequent in non-mass lesions, which were correlated with poor prognostic factors, such as a high nuclear grade, comedonecrosis, HER2 positivity, and an elevated Ki-67 index.
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Affiliation(s)
- Hwajin Cha
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ji Young Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung Kyu Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Park JW, Ko KH, Kim EK, Kuzmiak CM, Jung HK. Non-mass breast lesions on ultrasound: final outcomes and predictors of malignancy. Acta Radiol 2017; 58:1054-1060. [PMID: 28114809 DOI: 10.1177/0284185116683574] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Breast cancer can present as non-mass lesions (NMLs) on ultrasound. However, knowledge of and understanding about NMLs are scarce. Purpose To retrospectively investigate the final outcomes of sonographic breast NMLs and determine the clinical and radiologic variables associated with malignancy Material and Methods In our radiologic database of breast ultrasound examinations between 2011 and 2014, we found 119 women with 121 NMLs with available histopathologic or sonographic follow-up (over 2 years) data. We collected the clinical variables (patient's age, symptoms, and mammographic density) and histopathologic data as well as radiologic variables (mammographic and ultrasound findings) after retrospective review by two radiologists, the authors of the current paper, in consensus. We classified the ultrasound findings according to distribution (focal, linear or segmental, and regional) and associated features (calcification, architectural distortion, and ductal changes) and analyzed the associations between variables and malignancy using the t test and χ2 test. Results Of the 121 NMLs, 88 (72.7%) were benign and 33 (27.3%) were malignant. Ductal carcinoma in situ (DCIS) (17/33, 51.5%) and invasive ductal cancer with or without DCIS (13/33, 39.4%) comprised the main malignancies, and malignancy was significantly associated with palpability ( P = 0.000). Mammographic findings and sonographic distribution and associated features were significantly different between benign and malignant lesions ( P = 0.000, P = 0.004, and P = 0.001, respectively). Malignant lesions showed more frequent calcifications combined with asymmetry ( P = 0.000) on mammography and linear-segmental distributions ( P = 0.001) and associated calcifications ( P = 0.019) or architectural distortions ( P = 0.015) on ultrasound. Conclusion Breast NMLs on ultrasound showed high risk of malignancy. Symptoms and mammographic and ultrasound findings can be possible predictors of malignancy in NMLs.
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Affiliation(s)
- Jong Won Park
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyunggi-do, Republic of Korea
| | - Kyung Hee Ko
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyunggi-do, Republic of Korea
| | - Eun-Kyung Kim
- Department of Diagnostic Radiology, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | | | - Hae Kyoung Jung
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyunggi-do, Republic of Korea
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Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol 2015; 204:878-88. [PMID: 25794082 DOI: 10.2214/ajr.13.12221] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of our study was to compare the sonographic features of pure ductal carcinoma in situ (DCIS) lesions with the initial clinical presentation and histopathologic findings. MATERIALS AND METHODS The images and records of 691 patients with pure DCIS who underwent preoperative mammography and whole-breast sonography as part of staging workup in a single institution from January 1, 1996, through July 31, 2009, were reviewed. The BI-RADS sonography lexicon was used when reviewing the sonographic studies. Histopathologic features recorded included estrogen receptor (ER) status, nuclear grade, and presence or absence of comedonecrosis. Statistical comparisons were made using the Student t test, chi-square test, Fisher exact test, Kruskal-Wallis or Wilcoxon rank sum test, multiple logistic regression analysis, and Pearson correlation coefficient. RESULTS A total of 304 (44%) tumors were visible on mammography and sonography; 315 (46%), on mammography only; 58 (8%), on sonography only; and 14 (2%), on neither mammography nor sonography. The most common sonographic appearance of DCIS was an irregular hypoechoic mass with indistinct margins and normal posterior features that was indistinguishable from invasive carcinoma. Patients with symptomatic high-nuclear-grade DCIS, dense breasts, and comedonecrosis were younger and had larger tumors on sonography than asymptomatic women with nondense breasts and low-nuclear-grade and noncomedo DCIS. Women with ER-negative DCIS were older and had larger tumors on sonography than women with ER-positive DCIS. ER-negative tumors were more frequently visible on sonography than ER-positive tumors (p=0.007). High-grade DCIS (p<0.0001) and comedo DCIS (p<0.0001) presented more frequently as microcalcifications, architectural distortion, and ductal changes on sonography than low-grade DCIS or noncomedo DCIS. CONCLUSION Of the 691 pure DCIS lesions, 362 (52%) were visible on sonography and presented most commonly as a mass. Lesion visibility of DCIS on sonography was not related to nuclear grade or the presence of comedonecrosis.
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Sundara Rajan S, Verma R, Shaaban AM, Sharma N, Dall B, Lansdown M. Palpable ductal carcinoma in situ: analysis of radiological and histological features of a large series with 5-year follow-up. Clin Breast Cancer 2014; 13:486-91. [PMID: 24267733 DOI: 10.1016/j.clbc.2013.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 08/05/2013] [Accepted: 08/26/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Palpable pure DCIS is a rare entity that presents differently than screen-detected DCIS. The aim of this study was to evaluate the clinical, radiological, and pathological characteristics and management of pDCIS in a retrospective cohort of patients. PATIENTS AND METHODS Patients diagnosed with pDCIS from January 1999 to December 2011 were identified from an electronic patient database and were included in this study. RESULTS During this period, 669 cases of DCIS were diagnosed and 62 (9.3%) were pDCIS (mean age, 56.9 ± 15.1 years). The most common finding on ultrasound was mass in 43 patients (75%) and only 18 (33%) cases had calcification on mammography. The lesion was mammographically occult in 20 patients (37%). Ultrasound was more sensitive and delineated the pDCIS in 45 (80%) cases. Mean size of the pDCIS was 36.9 ± 30.4 mm and most were high grade (n = 42; 68%) and associated with comedo necrosis in 36 (59%). Most were oestrogen receptor (ER)-positive (n = 34; 62%), however 21 patients (38%) were ER-negative. Breast conservation was attempted in 30 patients (48%), however, because of involved margins further therapeutic surgery was needed in 10 patients (33%). Axillary surgery (sentinel lymph node biopsy or axillary nodal sampling) was performed in 34 patients (55%) and no lymph node metastasis was identified. During a medial follow-up of 60 months, 1 patient has developed a mastectomy scar recurrence and the rest remain disease-free. CONCLUSION Palpable DCIS is often occult on conventional radiological imaging and is generally associated with aggressive pathological features. Hence, careful individualized surgical planning through a multidisciplinary meeting is necessary for their management.
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Affiliation(s)
- Sreekumar Sundara Rajan
- Department of Breast Surgery, St. James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
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Kim JS, Lee SM, Cha ES. The diagnostic sensitivity of dynamic contrast-enhanced magnetic resonance imaging and breast-specific gamma imaging in women with calcified and non-calcified DCIS. Acta Radiol 2014; 55:668-75. [PMID: 24043881 DOI: 10.1177/0284185113505086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early detection of breast cancer reduces mortality. Therefore, diagnosis of ductal carcinoma in situ (DCIS) is important. PURPOSE 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. MATERIAL AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Chuncheongnam-do Seosan Medical Center, Chuncheongnam-do, Republic of Korea
| | - Eun Suk Cha
- Department of Radiology, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
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Elias SG, Adams A, Wisner DJ, Esserman LJ, van't Veer LJ, Mali WPTM, Gilhuijs KGA, Hylton NM. Imaging features of HER2 overexpression in breast cancer: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2014; 23:1464-83. [PMID: 24807204 DOI: 10.1158/1055-9965.epi-13-1170] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [(18)F]fluorodeoxyglucose positron emission tomography studies through February 2013. Of 68 imaging features that could be pooled (85 articles, 23,255 cancers; random-effects meta-analysis), 11 significantly related to HER2 overexpression. Results based on five or more studies and robustness in subgroup analyses were as follows: the presence of microcalcifications on mammography [pooled odds ratio (pOR), 3.14; 95% confidence interval (CI), 2.46-4.00] or ultrasound (mass-associated pOR, 2.95; 95% CI, 2.34-3.71), branching or fine linear microcalcifications (pOR, 2.11; 95% CI, 1.07-4.14) or extremely dense breasts on mammography (pOR, 1.37; 95% CI, 1.07-1.76), and washout (pOR, 1.57; 95% CI, 1.11-2.21) or fast initial kinetics (pOR, 2.60; 95% CI, 1.43-4.73) on MRI all increased the chance of HER2 overexpression. Maximum [(18)F]fluorodeoxyglucose standardized uptake value (SUVmax) was higher upon HER2 overexpression (pooled mean difference, +0.76; 95% CI, 0.10-1.42). These results show that several imaging features relate to HER2 overexpression, lending credibility to the hypothesis that imaging phenotype reflects cancer behavior. This implies prognostic relevance, which is especially relevant as imaging is readily available during diagnostic work-up.
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Affiliation(s)
| | - Arthur Adams
- Department of Radiology, University Medical Center Utrecht, Utrecht
| | | | | | - Laura J van't Veer
- Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | | | - Kenneth G A Gilhuijs
- Department of Radiology, University Medical Center Utrecht, Utrecht; Department of Radiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Departments of
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Kim SJ, Park YM, Jung HK. Nonmasslike lesions on breast sonography: comparison between benign and malignant lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:421-430. [PMID: 24567453 DOI: 10.7863/ultra.33.3.421] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare the imaging and clinical features of benign and malignant nonmasslike lesions in the breast. METHODS During a 2-year period at a single institution, 186 nonmasslike lesions in 158 women were pathologically confirmed through surgery or sonographically guided biopsy. The sonographic patterns (mottled, geographic, and indistinct) and distributions (focal and regional) were compared between benign and malignant lesions. The presence of sonographically visible calcifications, amount of color Doppler signals, presence of positive findings on mammography, and presence of symptoms were also compared between the two groups. RESULTS A total of 156 lesions (84%) were confirmed as benign and 30 (16%) as malignant. On sonography, malignant nonmasslike lesions more frequently had mottled and geographic patterns and regional distribution than benign lesions (P < .0001). Malignant lesions also more frequently had sonographically visible calcifications (40% versus 0%; P < 0.0001) and a greater amount of color Doppler signals than benign lesions (P < .0001). On mammography, malignant lesions more frequently had densities and calcifications than benign lesions (30.4% versus 7.1%; P = 0.0052; 73.9% versus 6.1%; P < .0001, respectively). Clinically, malignant lesions were more frequently palpable and accompanied by localized pain than benign lesions (50% versus 2.6%; P< .0001; 13.3% versus 0.6%; P = .0025). CONCLUSIONS The imaging and clinical features of malignant nonmasslike lesions differed significantly from those of benign nonmasslike lesions.
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea.
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Assessing the role of ultrasound in predicting the biological behavior of breast cancer. AJR Am J Roentgenol 2013; 200:284-90. [PMID: 23345347 DOI: 10.2214/ajr.12.8781] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this article is to correlate various ultrasound features of breast cancer with tumor grade, and with estrogen, progesterone, and ERRB2 (formerly HER2) receptor status as well as to assess the predictive value of these features. MATERIALS AND METHODS The features of breast cancers found by using ultrasound between January 2010 and June 2011 were reviewed for tumor size, margins, and posterior acoustic features. The tumor margins were classified into spiculated, angular, indistinct, lobulated or microlobulated, and circumscribed. The posterior acoustic features were classified into shadowing, enhancement, mixed pattern, and no change. The individual features were correlated with the estrogen receptor (ER)-progesterone receptor (PR) and ERRB2 receptor status and tumor grade. RESULTS Among 160 patients with breast cancer, 102 (63.8%) were ER-positive/PR-positive, 32 (20.0%) were ER-positive/PR-negative, and 26 (16.3%) were ER-negative/PR-negative (22 were triple-negative). Tumors with posterior shadowing have greater than nine times the odds of having ER-positive findings (95% CI, 2.09-40.81; p = 0.011) and greater than 13 times the odds of having a lower-grade tumor (I or II vs III; 95% CI, 4.90-36.54; p < 0.001) than those without posterior shadowing. Tumors with posterior enhancement have greater than eight times the odds of having at least one negative receptor (95% CI, 3.97-18.11; p < 0.001) and 24 times the odds of having a high-grade tumor (95% CI, 9.91-58.14; p < 0.001) than those without posterior enhancement. CONCLUSION The presence of posterior shadowing is strongly associated with an ER-positive and low-grade tumor, whereas the presence of posterior enhancement is strongly associated with a high-grade tumor and with moderate risk of being receptor negative.
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Mun H, Shin H, Kim H, Cha J, Kim H. Screening-detected calcified and non-calcified ductal carcinoma in situ: Differences in the imaging and histopathological features. Clin Radiol 2013. [DOI: 10.1016/j.crad.2012.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang LC, Sullivan M, Du H, Feldman MI, Mendelson EB. US Appearance of Ductal Carcinoma in Situ. Radiographics 2013; 33:213-28. [DOI: 10.1148/rg.331125092] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Park JS, Park YM, Kim EK, Kim SJ, Han SS, Lee SJ, In HS, Ryu JH. Sonographic findings of high-grade and non-high-grade ductal carcinoma in situ of the breast. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1687-1697. [PMID: 21098839 DOI: 10.7863/jum.2010.29.12.1687] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this study was to differentiate between high-grade and non-high-grade ductal carcinoma in situ (DCIS) of the breast on sonography. METHODS From October 2003 to August 2009, 76 DCIS lesions in 73 women who underwent sonography and mammography were included in this study. Lesions were confirmed by mastectomy, breast-conserving surgery, or surgical biopsy. Images were analyzed by 2 radiologists with consensus and were correlated with histologic grades. RESULTS Of the 76 lesions, 44 were classified as high--grade and 32 as non-high-grade DCIS. Fifty-seven lesions (75.0%) were identified on sonography, which revealed a mass in 30 cases, microcalcifications in 20, ductal changes in 4, and architectural distortion in 3. All cases with false-negative findings on sonography (n = 19) showed microcalcifications on mammography. On sonography, masses were more frequently found in non-high-grade (62.5%) than high-grade DCIS (22.7%; P < .01). No significant difference was seen in the sonographic features of masses between high-grade and non-high-grade DCIS. Microcalcifications were more common in high-grade (43.2%) than non-high-grade (3.1%) DCIS (P = .02). Most sonographically visible microcalcifications had associated findings such as ductal changes (n = 11), a mass (n = 7), or a hypoechoic area (n = 5). The detection rate of microcalcifications on sonography was higher in high-grade (62.9%) than non-high-grade DCIS (25.0%; P = .023). CONCLUSIONS Microcalcifications with associated ductal changes (11 of 31 [35.5%]) were the most common sonographic findings in high-grade DCIS. An irregular hypoechoic mass with an indistinct and microlobulated margin (13 of 26 [50.0%]) was the most frequent finding in non-high-grade DCIS.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Calcinosis
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Ultrasonography, Mammary
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Affiliation(s)
- Ji-Sung Park
- Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Triple-negative breast cancer: correlation between imaging and pathological findings. Eur Radiol 2009; 20:1111-7. [DOI: 10.1007/s00330-009-1656-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/14/2009] [Accepted: 10/09/2009] [Indexed: 11/26/2022]
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