The usefulness of ultrafast MRI evaluation for predicting histologic upgrade of ductal carcinoma in situ

Sorin Heo; Ah Young Park; Hae Kyoung Jung; Kyung Hee Ko; Yunju Kim; Jieun Koh

doi:10.1016/j.ejrad.2020.109519

The usefulness of ultrafast MRI evaluation for predicting histologic upgrade of ductal carcinoma in situ

Eur J Radiol. 2021 Mar:136:109519. doi: 10.1016/j.ejrad.2020.109519. Epub 2021 Jan 2.

Authors

Sorin Heo¹, Ah Young Park², Hae Kyoung Jung³, Kyung Hee Ko⁴, Yunju Kim⁵, Jieun Koh⁶

Affiliations

¹ Department of Radiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea. Electronic address: A196006@chamc.co.kr.
² Department of Radiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea. Electronic address: pay526@cha.ac.kr.
³ Department of Radiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea. Electronic address: AA40501@chamc.co.kr.
⁴ Department of Radiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea. Electronic address: yourheeya@cha.ac.kr.
⁵ Department of Radiology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea. Electronic address: radkyj5@cha.ac.kr.
⁶ Department of Radiology, Ilsan Medical Center, CHA University, 1205, Jungang-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10414, Republic of Korea. Electronic address: jekoh123@cha.ac.kr.

PMID: 33429208
DOI: 10.1016/j.ejrad.2020.109519

Abstract

Purpose: The purpose of this study was to investigate the usefulness of ultrafast MRI with conventional dynamic contrast-enhanced (DCE)-MRI for predicting histologic upgrade of ductal carcinoma in situ (DCIS) to invasive cancer.

Methods: This retrospective study enrolled 53 biopsy-proven DCIS lesions in 53 patients and divided into two groups based on postoperative histopathologic diagnoses: non-upgrade and upgrade to invasive cancer groups. Imaging features of conventional DCE-MRI and ultrafast MRI, and histopathologic features were reviewed and compared between the two groups. Interobserver agreements for MRI features were analyzed by two radiologists. The radiologic and histopathologic parameters for predicting histologic upgrade of DCIS were identified using multiple linear regression.

Results: Seventeen lesions (32.1 %) were histologically upgraded to invasive cancer after surgery. The interobserver agreement for ultrafast MRI parameters was excellent, and maximum slope (MS) and maximum enhancement (ME) showed the highest reliability (intraclass correlation coefficients, 0.907 and 0.897, respectively). The upgrade group showed significantly larger lesion size on MRI (median 40 mm [25^th to 75^th percentiles 16.0-83.0] vs. 18.5 mm [10.0-29.8], p < 0.001), higher MS (12.1 %/s [8.2-13.9] vs. 8.7 %/s [6.4-11.1], p = 0.004), and higher ME (236.5 % [153.7-253.7] vs. 175.4 % [140.1-207.7], p = 0.027) than non-upgrade group. Lesion size (≥ 20 mm), MS (> 11.5 %), and ME (> 229.1 %) were significant predictors for histologic upgrade, which could predict 10 cases of histologic upgrade (10/17, 58.8 %) without a false-positive case.

Conclusion: Preoperative ultrafast MRI with conventional DCE-MRI could be useful in management decisions for DCIS patients.

Keywords: Breast; Histologic underestimation; Magnetic resonance imaging; Neoplasms.

MeSH terms

Breast
Breast Neoplasms* / diagnostic imaging
Carcinoma, Intraductal, Noninfiltrating* / diagnostic imaging
Humans
Magnetic Resonance Imaging
Reproducibility of Results
Retrospective Studies