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Ductal carcinoma in situ: is there a role for MRI?

The purpose of our study is to report personal experience about 28 cases of Ductal Carcinoma In Situ (DCIS) studied with Magnetic Resonance Imaging (MRI). From September 1995 to December 2001, 28 women affected by DCIS lesions underwent contrast enhanced MRI. All patients were submitted previously to mammographic examination. The results of histopathological examination included: 19 DCIS and 9 DCIS with associated microinvasive component or microfoci of invasive ductal carcinoma (IDC). MRI was performed with a 1 T system. A three dimensional fast low-angle shot (FLASH) pulse sequence was used, with a repetition time (TR) of 14 ms, an echo time (TE) of 7 ms and a flip angle of 25 degrees. We evaluated the morphologic features of the enhancement, the enhancement rate and the signal time intensity curve. On MRI 26 out of 28 (92.85%) DCIS lesions showed contrast uptake. 17 out of 19 pure DCIS lesions demonstrated contrast enhancement: 5 showed a low, 7 indeterminate and 5 a strong enhancement. Morphologically, the enhancing lesion was focal in 9, segmental in 5 and linear branching in 3. Wash out was found in 5 cases, plateau curve in 9 and Type I curve in 3. There were 5 cases of multifocality. All DCIS with associated microinvasion demonstrated contrast enhancement: 2 out of 9 cases showed a low enhancement, 4 out of 9 showed an indeterminate enhancement and 3 out of 9 showed a strong enhancement. Morphologically the enhancing lesion was focal in 3 out of 9, segmental in 5 and linear branching in 1. The wash out was demonstrated in 4 cases out of 9, plateau curve in 4 and Type I curve in 1. There were 3 cases of multifocality. In conclusion, MR imaging sensitivity for DCIS detection is lower than that achieved for invasive breast cancer; however, contrast enhanced MR imaging can depict mammographically occult foci of DCIS. The MR imaging technique is of complementary value in better description of tumor size and in additional malignant lesions detection.