Breast MR-Imaging of Ductal Carcinoma In Situ: A Systematic Review

Abstract

Magnetic resonance imaging (MRI) of the breast has become a well-established method for detection of invasive breast carcinoma. However, the role and use of breast MRI for ductal carcinoma in situ (DCIS) has remained controversial. The purpose of this study was to assess the diagnostic performance of breast MRI for detection and characterization of pure DCIS based on the currently published reports. A systematic review was performed in which studies on breast MRI for diagnosis of patients with pure DCIS were selected. A total of 26 articles were finally included, a total of 1051 patients with 1059 lesions. Sensitivity for diagnosis of pure DCIS ranged from 58% to 100%, with an overall of 84%. Sensitivity was highest for high-grade DCIS (95%). Overall specificity was 74%. The majority of DCIS lesions were characterized as non-mass-like enhancement (75%) with a segmental distribution of enhancement (50%). Suspicious kinetic curves were found in 49% of the DCIS cases. A few studies reported on size assessment. This review shows that MRI has a moderate sensitivity for detection of DCIS in general, and a good sensitivity for high-grade DCIS. The morphologic and kinetic appearance of DCIS can be very variable. Although mammography is the current standard for detection of DCIS, MRI could help improve the ability to diagnose DCIS, especially in high-grade DCIS.