Which findings on magnetic resonance mammography (breast MRI) are characteristic of ductal carcinoma in situ (DCIS)?

Updated: Feb 25, 2019
  • Author: Preeti Gupta, MD, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

DCIS is a biologically diverse disease. It may be low grade, intermediate grade, or high-grade. The most common morphologic feature of DCIS on MRI is nonmass enhancement (NME). NME is described in the ACR BI-RADS lexicon as enhancement that is not a mass but is still distinct from the surrounding normal breast tissue.

DCIS mostly presents as NME. Segmental and ductal patterns of enhancement are more suspicious than regional and diffuse enhancement. Clumped NME is the most common type of NME seen with DCIS. Clustered ringlike enhancement has been described as a type of NME that is strongly suspicious for DCIS. In a smaller number of cases, DCIS may be seen on MRI as a mass with irregular margins.

DCIS frequently shows slower initial and plateau or persistent delayed-phase enhancement. It is well known that DCIS may not show kinetic features that are regarded as typical for malignancy.

The variability of enhancement of DCIS is due to variations in neoangiogenesis, which in turn is somewhat related to the histologic grade. [62] Between 15 and 40% of DCIS cases show minimal to moderate enhancement that is indistinguishable from that of normal glandular tissues. This pattern tends to occur in low-grade DCIS, [62] but it has also been described in comedocarcinoma. [63] DCIS of a high nuclear grade tends to have stronger enhancement than that of a lower-grade DCIS. Note that 40% of DCIS cases are not calcified, even when they are high grade [64] .

Paradoxically, although breast MRI is unsuitable for an evaluation of microcalcifications, it sometimes shows the extent of DCIS (calcified or noncalcified) better than mammography. Because this information has the potential to change the type and extent of surgical excision, breast MRI can prove useful for the local staging of DCIS, particularly when the noncalcified component is significant.


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