Rationale and Objectives
To evaluate the role of apparent diffusion coefficient (ADC) in distinguishing ductal carcinoma in situ (DCIS) grades and identifying microinvasive and/or invasive disease in the preoperative evaluation of patients with core biopsy-proven DCIS.
Materials and Methods
Research Ethics Board-approved study with informed consent from 81 women (age, 36–84 years) scheduled for core-biopsy with results of 82 noninvasive breast carcinomas. All patients were assessed preoperatively by diffusion sequence in addition to contrast magnetic resonance imaging (MRI). Lesion morphology and ADC values were recorded. The Kruskal–Wallis or one-way analysis of variance test and Pearson correlation coefficient were used to study the association between ADC and MRI lesion characteristics. Logistic regression analysis was used to evaluate the ability of ADC to predict the presence of invasion.
Results
Surgical pathology demonstrated associated invasive cancer in 26.8%, microinvasion in 14.6%, and pure DCIS in 58.5%. The minimum regions of interest (ROI)–based ADC was significantly different among the following three groups ( P < .001, Kruskal–Wallis test): 0.98 × 10 −3 mm 2 /s ± 0.25 for pure DCIS, 0.82 × 10 −3 mm 2 /s ± 0.20 for DCIS with microinvasion, and 0.71 × 10 −3 mm 2 /s ± 0.27 for DCIS with invasive disease. Based on logistic regression analysis, the minimum ROI-based ADC of 0.56 × 10 −3 mm 2 /s was a significant predictor for invasive disease (odds ratio = 0.02, 95% confidence interval [0.002, 0.207], P = .001). Regardless of the field strength (1.5 vs. 3.0 T) ADC values of high-grade and non–high-grade DCIS were not significantly different.
Conclusions
Pure DCIS had the highest “ROI-based” ADC measured using 1.5 T or 3.0 T. The ADC was able to identify microinvasion or invasive cancer in biopsy-proven DCIS lesions but not to distinguish the DCIS grades.
Ductal carcinoma in situ (DCIS) of the breast is a preinvasive neoplasm characterized by a proliferation of malignant ductal epithelial cells that are confined within the basement membrane of preexisting duct and/or lobular units of the breast . Since the early 1980s, the prevalence of DCIS has been rising as a result of the adoption of widespread mammographic screening for breast cancer and the advances in mammographic techniques, image processing, and interpretation of digital imaging .
Magnetic resonance imaging (MRI) has been useful in the preoperative setting of invasive breast cancer . Specifically, dynamic contrast-enhanced (DCE) MRI has shown strong capability in the detection of invasive breast cancer with a sensitivity approaching 100% . The reported sensitivity of DCIS detection on MRI ranges from 77% to 96%, being largely impeded by challenges in distinguishing images suggestive of in situ cancer from benign and atypical proliferative processes, thus resulting in a higher false positive rate .
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Materials and methods
Study Design and Patient Selection
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MRI Examinations
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Imaging Analysis
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Histologic Classification
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Statistical Analysis
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Results
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Table 1
Comparison of Three Nuclear Grades of DCIS Stratified by the Presence or Absence of Microinvasion and/or Invasive Cancer in the Surgical Specimens
Microinvasion/Invasive Tumor DCIS Grades by Surgical Pathology Grade 1 DCIS Grade 2 DCIS Grade 3 DCIS All Grades Absent “pure DCIS,” n (%) 5 (71.4) 21 (70.0) 22 (48.9) 48 (58.5) DCIS + invasion, n (%) 2 (28.6) 7 (23.3) 13 (28.9) 22 (26.8) DCIS + micro invasion, n (%) 0 (0.0) 2 (6.7) 10 (22.2) 12 (14.6) Total 7 (100) 30 (100) 45 (100) 82 (100)
DCIS, ductal carcinoma in situ.
Note: Grades 1 and 2 DCIS are grouped into “non–high grade,” whereas grade 3 is “high grade.”
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Discussion
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