Imaging for the Diagnosis and Management of Ductal Carcinoma In Situ

Department of Radiology, Breast Imaging Center, Emory University Hospital, WCI Bldg, 1365-C Clifton Rd, Ste C1104, Atlanta, GA 30322, USA.
JNCI Monographs 10/2010; 2010(41):214-7. DOI: 10.1093/jncimonographs/lgq037
Source: PubMed


Diagnosis of ductal carcinoma in situ (DCIS) has increased dramatically in parallel with the increased use of screening mammography. There are specific mammographic findings, most associated with shapes (amorphous, fine and coarse pleomorphic, and fine linear) and distributions (linear and segmental) of calcifications that permit a reasonable sensitivity for detection of DCIS without an unreasonable decrease in specificity, especially in view of the dramatic decrease in breast cancer mortality associated with early detection. While some DCIS may never progress to invasive disease, at this time, we cannot make that separation. This should be an active area for research.

6 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare tumour characteristics between cancers detected with screen-film mammography (SFM) and digital mammography (DM) and to evaluate changes in positive predictive values (PPVs) for further assessments, for invasive procedures and for distinct radiological patterns in recalled women. 242,838 screening mammograms (171,191 SFM and 71,647 DM) from 103,613 women aged 45-69 years, performed in four population-based breast cancer screening programmes in Spain, were included. The tumour characteristics and PPVs of each group were compared. Radiological patterns (masses, calcifications, distortions and asymmetries) among recalled women were described and PPVs were evaluated. The percentages of ductal carcinoma in situ (DCIS) were higher in DM than in SFM both in the first [18.5% vs. 15.8%(p = 0.580)] and in successive screenings [23.2% vs. 15.7%(p = 0.115)]. PPVs for masses, asymmetries and calcifications were higher in DM, being statistically significant in masses (5.3% vs. 3.9%; proportion ratio: 1.37 95%CI: 1.08-1.72). Among cancers detected by calcifications, the percentage of DCIS was higher in DM (60.3% vs. 46.4%, p = 0.060). PPVs were higher when DM was used, both for further assessments and for invasive procedures, with similar cancer detection rates and no statistically significant differences in tumour characteristics. The greatest improvements in PPVs were found for masses.
    European Radiology 05/2011; 21(9):2020-8. DOI:10.1007/s00330-011-2143-1 · 4.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ductal carcinoma in situ of the breast (DCIS) represents a challenge in mammographic screening due to its unknown progression into invasive cancer. The majority of the DCIS is detected due to signs of calcifications on the mammograms. To analyze the combinations of mammographic morphology and distribution of calcifications by Van Nuys nuclear grade (grade). A total of 217 DCIS diagnosed in women aged 50-69 years old who participated in the Norwegian Breast Cancer Screening Program in the period November 1995 to December 2007 were reviewed by four breast imaging specialists. The mammograms were classified according to the morphology and distribution of the calcifications, using BI-RADS nomenclature. Chi square test was used to compare the groups of morphology and distribution by grade. Calcifications were identified in 93% (202/217) of the cases, 15% (30/202) as grade 1 and 74% (149/202) as grade 3. Fine pleomorphic calcifications were seen in 38% (77/202) of the lesions and fine linear and fine linear branching in 31% (62/202). Sixty-nine percent (53/77) of the fine pleomorphic and 84% (52/62) of the fine linear and fine linear branching calcifications were high grade lesions. Grouped distribution was seen in about half of all the cases (104/202). Among the high grade lesions with fine pleomorphic or fine linear and fine linear branching calcifications, 75% (40/53) and 69% (36/52), respectively, had grouped or segmental distribution. DCIS presented overlapping groups of morphology and distribution of calcification by grade, but fine pleomorphic and fine linear and fine linear branching calcifications with grouped and segmental distributions were associated with high grade DCIS. Seeking for further knowledge that allows separation of non-high grade from high grade DCIS has to continue to improve the quality of mammographic screening.
    Acta Radiologica 06/2011; 52(5):481-7. DOI:10.1258/ar.2011.100357 · 1.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ductal carcinoma in situ (DCIS) is a preinvasive malignancy that currently accounts for over 20% of newly diagnosed breast cancers in the US. This article reviews how clinical magnetic resonance imaging methods are being implemented for the detection, diagnosis and characterization of DCIS. Research strategies that are being pursued to help realize the full potential for magnetic resonance imaging to improve the outcomes of patients diagnosed with DCIS are discussed. Semin Ultrasound CT MRI 32:306-318 (c) 2011 Elsevier Inc. All rights reserved.
    Seminars in Ultrasound CT and MRI 08/2011; 32(4):306-18. DOI:10.1053/j.sult.2011.02.007 · 1.20 Impact Factor
Show more