Ultrasonographic features of ductal carcinoma in situ: analysis of 219 lesions

Jun Kang Li; Huan Fan Wang; Yan He; Yong Huang; Gang Liu; Zhi Li Wang

doi:10.21037/gs-20-428

Ultrasonographic features of ductal carcinoma in situ: analysis of 219 lesions

Gland Surg. 2020 Dec;9(6):1945-1954. doi: 10.21037/gs-20-428.

Authors

Jun Kang Li¹, Huan Fan Wang², Yan He³, Yong Huang⁴, Gang Liu⁵, Zhi Li Wang³

Affiliations

¹ Department of Ultrasound, Chinese People's Liberation Army 63820 Hospital, Mianyang, China.
² Department of Ultrasound, Second Affiliated Hospital of Xingtai Medical College, Xingtai, China.
³ Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China.
⁴ Department of Pathology, Chinese People's Liberation Army 63820 Hospital, Mianyang, China.
⁵ Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China.

Abstract

Background: The purpose of this paper is to clarify the ultrasonographic features and classification of ductal carcinoma in situ (DCIS), and to evaluate the ability of ultrasonography in the prediction of DCIS.

Methods: The clinical data, gray-scale ultrasound images and pathological results of 219 DCIS lesions that detected in 203 consecutive patients who underwent ultrasonography and surgery in our hospital from January 1, 2014 to December 31, 2019 were collected retrospectively. Ultrasonographic features and classification of DCIS were summarized, and the accuracy of ultrasonography in predicting different ultrasonographic findings of DCIS were compared.

Results: Among the 219 DCIS lesions, 91 (41.6%) presented as mass-like lesions and 128 (58.4%) were non-mass-like lesions. For the 91 mass-like DCIS lesions, 79 were hypoechoic solid masses, 12 were cystic-solid structures. For the 128 non-mass-like DCIS lesions, 114 were hypoechoic areas, 10 were ductal dilatation accompanied with intraductal solid components, and 4 were multiple punctate echogenic foci only. The diagnostic accuracy of ultrasound for the 219 DCIS lesions was 81.7% (179/219). The diagnostic accuracy of mass-like DCIS lesions was 90.1% (82/91), which was significantly higher than that in non-mass-like DCIS lesions [75.8% (97/128), P=0.007]. The diagnostic accuracy of hypoechoic solid masses was significantly higher than those of the other ultrasonographic findings (P=0.002). Ducts abnormalities were detected in 45 (20.5%) lesions and punctate echogenic foci in 134 (61.2%) lesions. The diagnostic accuracy of lesions with ducts abnormalities was 93.3% (42/45), which was significantly higher than that in lesions without ducts abnormalities [78.7% (137/174), P=0.024]. The diagnostic accuracy of lesions with punctate echogenic foci was 92.5% (124/134), which was significantly higher than that in lesions without punctate echogenic foci [64.7% (55/85), P=0.000].

Conclusions: DCIS lesions can effectively be recognized as mass-like lesions and non-mass-like lesions by ultrasound. Hypoechoic areas and hypoechoic solid masses were the most common ultrasonographic features of DCIS. Ducts abnormalities and punctate echogenic foci were helpful for the diagnosis of DCIS.

Keywords: Ductal carcinoma in situ (DCIS); duct abnormality; echogenic foci; ultrasonography.