High-Grade Ductal Carcinoma In Situ

Click to Enlarge Click to Enlarge Click to Enlarge For 6 weeks, a 68-year-old woman had had sharp pain in the left breast that radiated to the left arm and back. The pain was worse on palpation; ibuprofen provided only mild relief. She denied nipple discharge, skin discoloration, and fever. She had no family history of breast cancer. Results of a biopsy of the left breast 6 years earlier were benign. Her most recent mammogram (A), 4 weeks earlier, was negative. Cardiac, lung, and abdominal findings were normal. A tender 0.5-cm cyst was noted at the 12 o'clock position. There were no palpable lymph nodes, discharge, skin retraction, or erythema. An ultrasonogram of the left breast showed no suspicious lesions (B). Despite the previous negative findings, breast cancer was strongly suspected. The patient underwent MRI of the left breast, which showed a 1 3 3-cm mass at the 12 o'clock position and another lesion at the 4 o'clock position (C). Subsequent biopsy results revealed high-grade ductal carcinoma in situ (DCIS). The breast surgeon recommended a left total mastectomy and sentinel node biopsy, with possible axillary dissection. Excision of a papilloma found in the right breast on MRI was also recommended because core biopsy results showed atypical features. Currently, about 20% of diagnosed breast cancers are preinvasive, compared with 2% before the advent of mammographic screening.1 Mammography is considered to be more sensitive than MRI in diagnosing DCIS. However, in a recent German study that included 167 patients with DCIS, 72 mammographically occult intraductal cancers were detected by MRI.1 Of the cases of DCIS diagnosed by MRI alone, 60% were high-grade. Although further investigation is needed, MRI may play an increasingly important role in the diagnosis of DCIS, especially of high-grade DCIS.1 References: REFERENCE: 1. Kuhl CK, Schrading S, Bieling HB, et al. MRI for the diagnoses of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370:485-492.