Background

There are limited data from clinical trials describing preoperative MRI features and performance in the evaluation of mammographically detected ductal carcinoma in situ (DCIS).

Purpose

To report qualitative MRI features of DCIS, MRI performance in the identification of additional disease, and associations of imaging features with pathologic, genomic, and surgical outcomes from the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) E4112 trial.

Materials and Methods

Secondary analyses of a multicenter prospective clinical trial from the ECOG-ACRIN Cancer Research Group included women with DCIS diagnosed with conventional imaging techniques (mammography and US), confirmed via core-needle biopsy (CNB), and enrolled between March 2015 and April 2016 who were candidates for wide local excision (WLE) based on conventional imaging and clinical examination results. DCIS MRI features and pathologic features from CNB and excision were recorded. Each woman without invasive upgrade of the index DCIS at WLE received a 12-gene DCIS score. MRI performance metrics were calculated. Associations of imaging features with invasive upgrade, dichotomized DCIS score (<39 vs ≥39), and single WLE success were estimated in uni- and multivariable analyses.

Results

Among 339 women (median age, 60 years; interquartile range, 51–66 years), most DCIS cases showed nonmass enhancement (NME) (195 of 339 [58%]) on MRI scans with larger median size than on mammograms (19 mm vs 12 mm; P < .001). Positive predictive value of MRI-prompted CNBs was 32% (21 of 66) (95% CI: 22, 44), yielding an additional cancer detection rate of 6.2% (21 of 339) (95% CI: 4.1, 9.3). MRI false-positive rate was 14.2% (45 of 318) (95% CI: 10.7, 18.4). No imaging features were associated with invasive upgrade or DCIS score (P = .05 to P = .95). Smaller size and focal NME distribution at MRI were linked to single WLE success (P < .001).

Conclusion

Preoperative MRI depicted ductal carcinoma in situ (DCIS) diagnosed with conventional imaging most commonly as nonmass enhancement, with larger median span than mammography, and additional cancer detection rate of 6.2%. MRI features of this subset of DCIS did not enable prediction of pathologic or genomic outcomes.

Clinical trial registration no. NCT02352883

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Kuhl in this issue.

An earlier incorrect version of this article appeared online. This article was corrected on August 4, 2021.

中文翻译：

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新诊断导管原位癌的术前乳房 MRI：多中心环境中的成像特征和性能（ECOG-ACRIN E4112 试验）

背景

描述术前 MRI 特征和评估乳房 X 线检查检测到的导管原位癌 (DCIS) 表现的临床试验数据有限。

目的

报告 DCIS 的定性 MRI 特征、MRI 在识别其他疾病方面的表现，以及影像学特征与病理、基因组和手术结果的关联，来自东部肿瘤协作组-美国放射成像网络学院 (ECOG-ACRIN) E4112 试验.

材料和方法

ECOG-ACRIN 癌症研究小组的一项多中心前瞻性临床试验的二次分析包括使用常规成像技术（乳房 X 线摄影和超声）诊断的 DCIS 女性，通过核心针活检 (CNB) 确认，并在 2015 年 3 月至 2016 年 4 月期间入组，根据常规影像学和临床检查结果，他们是广泛局部切除术 (WLE) 的候选者。记录来自 CNB 和切除的 DCIS MRI 特征和病理特征。在 WLE 中，每位未对 DCIS 指数进行侵入性升级的女性都获得了 12 基因 DCIS 评分。计算MRI性能指标。在单变量和多变量分析中估计了成像特征与侵入性升级、二分 DCIS 评分（<39 vs ≥39）和单一 WLE 成功的关联。

结果

在 339 名女性（中位年龄，60 岁；四分位距，51-66 岁）中，大多数 DCIS 病例在 MRI 扫描中显示非肿块增强（NME）（339 名中的 195 名 [58%]），其中位尺寸大于乳房 X 线照片（19 毫米）与 12 毫米相比；P < .001）。MRI 提示 CNB 的阳性预测值为 32%（66 个中的 21 个）（95% CI：22, 44），癌症检出率为 6.2%（339 个中的 21 个）（95% CI：4.1, 9.3）。MRI 假阳性率为 14.2%（318 人中有 45 人）（95% CI：10.7, 18.4）。没有影像学特征与侵入性升级或 DCIS 评分相关（P = .05 至P = .95）。MRI 上较小的尺寸和局灶性 NME 分布与单次 WLE 成功有关 ( P < .001)。

结论

术前 MRI 显示导管原位癌 (DCIS) 以常规影像诊断最常见为非肿块增强，中位跨度大于乳房 X 线摄影术，癌症检出率为 6.2%。该 DCIS 子集的 MRI 特征无法预测病理或基因组结果。

临床试验注册号 NCT02352883

© 北美放射学会，2021

本文提供在线补充材料。

另见本期库尔的社论。

这篇文章的早期错误版本出现在网上。本文于 2021 年 8 月 4 日更正。