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From the Departments of Surgery (ESH, LJE), Pathology (NW), and Radiology (KK, YL, NMH), University of California–San Francisco, San Francisco, California.
Correspondence: Address correspondence and reprint requests to: E. Shelley Hwang, MD, UCSF Department of Surgery, 1600 Divisadero Street, Room B611, San Francisco, CA 94115; Fax: 415-353-9571; E-mail: shelley.hwang{at}ucsfmedctr.org
Background: Although magnetic resonance imaging (MRI) has been shown to be a sensitive imaging tool for invasive breast cancers, its utility in ductal carcinoma-in-situ (DCIS) of the breast remains controversial. We studied the performance of MRI in patients with known DCIS for assessment of residual disease, occult invasion, and multicentricity to determine the clinical role of MRI in this setting.
Methods: Fifty-one patients with biopsy-proven DCIS underwent contrast-enhanced MRI before surgical treatment. Pre-, early post-, and late postcontrast three-dimensional gradient echo images were obtained and MRI findings were correlated with histopathology. When possible, the performance of MRI and mammography was compared.
Results: The accuracy of MRI was 88% in predicting residual disease, 82% in predicting invasive disease, and 90% in predicting multicentricity. The performance of MRI was equivalent in the core biopsy group when compared with the surgical biopsy group. For occult invasion only, MRI and mammography were equivalent. However, overall, MRI was more sensitive and had a higher negative predictive value than mammography.
Conclusions: MRI of DCIS can serve as a useful adjunct to mammography by providing a more accurate assessment of the extent of residual or multicentric disease. The performance of MRI is not significantly affected by antecedent surgical excision. MRI may be particularly valuable if preoperatively negative.
Key Words: Breast cancer • Ductal carcinoma-in-situ • Magnetic resonance imaging • Comparative studies • Mammography
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