Can Mammography and Magnetic Resonance Imaging Predict the Preoperative Size and Nuclear Grade of Pure Ductal Carcinoma In Situ?

TL;DR

This study explores how mammography and MRI can predict the size and severity of pure ductal carcinoma in situ before surgery.

Contribution

The study identifies MRI as more effective than mammography for detecting and estimating DCIS size and links imaging features to nuclear grade.

Findings

MRI detected DCIS in 95.5% of patients, outperforming mammography at 91.1%.

MRI diffusion restriction was associated with high-grade DCIS (p = 0.043).

Both imaging methods overestimated tumor size compared to histopathological measurements.

Abstract

Background/Objectives: Thirty to fifty percent of ductal carcinoma in situ (DCIS) cases are high-grade and at risk of progressing to invasive carcinoma. The most important treatment-related risk factor for recurrence is the presence of residual DCIS. The aim of our study was to evaluate the relationship between size and imaging features on preoperative mammography and magnetic resonance imaging (MRI) and histopathological size and nuclear grade in patients with pure DCIS. Methods: Between 2015 and 2023, 90 patients who underwent surgery for DCIS, had no microinvasive/invasive component, and underwent a preoperative mammography and MRI were included in this study. Results: DCIS was detected in 91.1% of patients using mammography and 95.5% using MRI. Microcalcifications (MCs) were most common in mammography (85.4%). Thin pleomorphic and thin linear branching MCs were detected in 42% of high-grade DCIS, while amorphous (42%) MCs were most common in low-grade DCIS. In low-grade DCIS cases, a grouped distribution of MCs was observed most commonly (69%). There was a statistically significant difference between DCIS groups in terms of MC morphology and distribution (p = 0.043, p = 0.005, respectively). Diffusion restriction on MRI was associated with high-grade DCIS (p = 0.043). The tumor size was greater than the pathological size and correlated poorly with mammography and moderately with MRI. Conclusions: Compared to mammography, MRI is more effective in detecting and estimating the size of DCIS. Both methods overestimate tumor size compared to histopathological size. The nuclear grade is associated with a poor prognosis and local recurrence in DCIS.

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