Imaging features that distinguish pure ductal carcinoma in situ (DCIS) from DCIS with microinvasion

Wang,Hongli; Lin,Jinjiang; Lai,Jianguo; Tan,Cui; Yang,Yaping; Gu,Ran; Jiang,Xiaofang; Liu,Fengtao; Hu,Yue; Su,Fengxi

doi:10.3892/mco.2019.1891

Imaging features that distinguish pure ductal carcinoma in situ (DCIS) from DCIS with microinvasion

Authors:
- Hongli Wang
- Jinjiang Lin
- Jianguo Lai
- Cui Tan
- Yaping Yang
- Ran Gu
- Xiaofang Jiang
- Fengtao Liu
- Yue Hu
- Fengxi Su
View Affiliations

Affiliations: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat‑sen Memorial Hospital, Sun Yat‑sen University, Guangzhou, Guangdong 510120, P.R. China, Department of Radiology, The First Affiliated Hospital, Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
Published online on: July 3, 2019 https://doi.org/10.3892/mco.2019.1891
Pages: 313-319

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Patients with ductal carcinoma in situ with microinvasion (DCISM) have worse cancer‑specific survival, disease‑free survival and overall survival, and a higher mortality rate compared with patients with ductal carcinoma in situ (DCIS). Distinguishing DCISM from DCIS via preoperative imaging could help to predict the prognosis of patients. The present study compared the sonographic and mammographic features of patients with DCIS and DCISM. A total of 147 women (94 patients with DCIS and 53 patients with DCISM) were retrospectively included. The sonographic lesions were classified as either masses or non‑mass abnormalities. The lesions observed on mammography were classified as calcifications only, mass, asymmetry or architectural distortion. Statistical comparisons were performed using the Mann‑Whitney U test, χ2 test, Fisher's exact test and multiple logistic regression analysis. Univariate and multivariate analyses showed that the presence of calcifications (P=0.038) and vascularity (P=0.025) on sonography were associated with DCISM. Furthermore, a lager distribution of calcifications was associated with a higher likelihood of DCISM (P=0.002). In conclusion, the presence of calcifications and vascularity on sonography or a lager distribution of calcifications on mammography may suggest DCISM.

View Figures

View References

1	Schnitt SJ, Silen W, Sadowsky NL, Connolly JL and Harris JR: Ductal carcinoma in situ (intraductal carcinoma) of the breast. N Engl J Med. 318:898–903. 1988. View Article : Google Scholar : PubMed/NCBI
2	Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, Borgen PI, Clark G, Edge SB, Hayes DF, et al: Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol. 20:3628–3636. 2002. View Article : Google Scholar : PubMed/NCBI
3	Wang W, Zhu W, Du F, Luo Y and Xu B: The demographic features, clinicopathological characteristics and cancer-specific outcomes for patients with microinvasive breast cancer: A SEER database analysis. Sci Rep. 7:420452017. View Article : Google Scholar : PubMed/NCBI
4	Okumura Y, Yamamoto Y, Zhang Z, Toyama T, Kawasoe T, Ibusuki M, Honda Y, Iyama K, Yamashita H and Iwase H: Identification of biomarkers in ductal carcinoma in situ of the breast with microinvasion. BMC Cancer. 8:2872008. View Article : Google Scholar : PubMed/NCBI
5	Vieira CC, Mercado CL, Cangiarella JF, Moy L, Toth HK and Guth AA: Microinvasive ductal carcinoma in situ: Clinical presentation, imaging features, pathologic findings, and outcome. Eur J Radiol. 73:102–107. 2010. View Article : Google Scholar : PubMed/NCBI
6	Yao JJ, Zhan WW, Chen M, Zhang XX, Zhu Y, Fei XC and Chen XS: Sonographic features of ductal carcinoma in situ of the breast with microinvasion: Correlation with clinicopathologic findings and biomarkers. J Ultrasound Med. 34:1761–1768. 2015. View Article : Google Scholar : PubMed/NCBI
7	Sopik V, Sun P and Narod SA: Impact of microinvasion on breast cancer mortality in women with ductal carcinoma in situ. Breast Cancer Res Treat. 167:787–795. 2018. View Article : Google Scholar : PubMed/NCBI
8	Fang Y, Wu J, Wang W, Fei X, Zong Y, Chen X, Huang O, He J, Chen W, Li Y, et al: Biologic behavior and long-term outcomes of breast ductal carcinoma in situ with microinvasion. Oncotarget. 7:64182–64190. 2016. View Article : Google Scholar : PubMed/NCBI
9	Gwak YJ, Kim HJ, Kwak JY, Lee SK, Shin KM, Lee HJ, Kim GC, Jang YJ, Han MH, Park JY and Jung JH: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52:364–371. 2011. View Article : Google Scholar : PubMed/NCBI
10	Breast Imaging Reporting and Data System (BI-RADS). 5th. American College of Radiology; Reston, VA: 2013
11	Penault-Llorca F, André F, Sagan C, Lacroix-Triki M, Denoux Y, Verriele V, Jacquemier J, Baranzelli MC, Bibeau F, Antoine M, et al: Ki67 expression and docetaxel efficacy in patients with estrogen receptor-positive breast cancer. J Clin Oncol. 27:2809–2815. 2009. View Article : Google Scholar : PubMed/NCBI
12	Zhang W, Gao EL, Zhou YL, Zhai Q, Zou ZY, Guo GL, Chen GR, Zheng HM, Huang GL and Zhang XH: Different distribution of breast ductal carcinoma in situ, ductal carcinoma in situ with microinvasion, and invasion breast cancer. World J Surg Oncol. 10:2622012. View Article : Google Scholar : PubMed/NCBI
13	Ozkan-Gurdal S, Cabioglu N, Ozcinar B, Muslumanoglu M, Ozmen V, Kecer M, Yavuz E and Igci A: Factors predicting microinvasion in Ductal Carcinoma in situ. Asian Pac J Cancer Prev. 15:55–60. 2014. View Article : Google Scholar : PubMed/NCBI
14	Sue GR, Lannin DR, Killelea B and Chagpar AB: Predictors of microinvasion and its prognostic role in ductal carcinoma in situ. Am J Surg. 206:478–481. 2013. View Article : Google Scholar : PubMed/NCBI
15	Lee MH, Ko EY, Han BK, Shin JH, Ko ES and Hahn SY: Sonographic findings of pure ductal carcinoma in situ. J Clin Ultrasound. 41:465–471. 2013. View Article : Google Scholar : PubMed/NCBI
16	Watanabe T, Yamaguchi T, Tsunoda H, Kaoku S, Tohno E, Yasuda H, Ban K, Hirokaga K, Tanaka K, Umemoto T, et al: Ultrasound image classification of ductal carcinoma in situ (DCIS) of the breast: Analysis of 705 DCIS lesions. Ultrasound Med Biol. 43:918–925. 2017. View Article : Google Scholar : PubMed/NCBI
17	Nagashima T, Hashimoto H, Oshida K, Nakano S, Tanabe N, Nikaido T, Koda K and Miyazaki M: Ultrasound demonstration of mammographically detected microcalcifications in patients with ductal carcinoma in situ of the breast. Breast Cancer. 12:216–220. 2005. View Article : Google Scholar : PubMed/NCBI
18	Rauch GM, Kuerer HM, Scoggins ME, Fox PS, Benveniste AP, Park YM, Lari SA, Hobbs BP, Adrada BE, Krishnamurthy S and Yang WT: Clinicopathologic, mammographic, and sonographic features in 1187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. 139:639–647. 2013. View Article : Google Scholar : PubMed/NCBI
19	Yang WT, Suen M, Ahuja A and Metreweli C: In vivo demonstration of microcalcification in breast cancer using high resolution ultrasound. Br J Radiol. 70:685–690. 1997. View Article : Google Scholar : PubMed/NCBI
20	Gufler H, Buitrago-Téllez CH, Madjar H, Allmann KH, Uhl M and Rohr-Reyes A: Ultrasound demonstration of mammographically detected microcalcifications. Acta Radiol. 41:217–221. 2000. View Article : Google Scholar : PubMed/NCBI
21	Folkman J: What is the evidence that tumors are angiogenesis dependent? J Natl Cancer Inst. 82:4–6. 1990. View Article : Google Scholar : PubMed/NCBI
22	Cao Y, Paner GP, Kahn LB and Rajan PB: Noninvasive carcinoma of the breast: Angiogenesis and cell proliferation. Arch Pathol Lab Med. 128:893–896. 2004.PubMed/NCBI
23	Dershaw DD, Abramson A and Kinne DW: Ductal carcinoma in situ: Mammographic findings and clinical implications. Radiology. 170:411–415. 1989. View Article : Google Scholar : PubMed/NCBI
24	Stomper PC, Connolly JL, Meyer JE and Harris JR: Clinically occult ductal carcinoma in situ detected with mammography: Analysis of 100 cases with radiologic-pathologic correlation. Radiology. 172:235–241. 1989. View Article : Google Scholar : PubMed/NCBI
25	Lagios MD, Westdahl PR, Margolin FR and Rose MR: Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer. 50:1309–1314. 1982. View Article : Google Scholar : PubMed/NCBI
26	Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS and Ioffe OB: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233:830–849. 2004. View Article : Google Scholar : PubMed/NCBI
27	Kolb TM, Lichy J and Newhouse JH: Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: An analysis of 27,825 patient evaluations. Radiology. 225:165–175. 2002. View Article : Google Scholar : PubMed/NCBI