Mri detecting high grade dcis
I am up late, and decided to do a little research on mri's and dcis. I found the following article intriguing, which put forth a question on high grade dcis. According to an ariticle I read, high grade dcis shows itself differently on an mri than low grade dcis. The article I read said it is detected because it has begun to develop its own blood supply...vessels. I thought all dcis was completely contain in the ducts and had no blood supply.
Below, is part of the article I read.
The interesting feature of our data is that, very unexpectedly, MRI has proved not only on a level with mammography in the detection of in-situ carcinomas but, in fact, significantly superior - particularly in the diagnosis of high-grade in-situ carcinoma. In the detection of 167 in-situ carcinomas the sensitivity of mammography was 51%, MRI was 92% - figures that are clearly in favour of MRI. Mammography was particularly insufficient to diagnose high-grade in-situ carcinomas: it could not detect over half of the high-grade DCIS - because they had not developed any calcifications!
‘It appears that a relevantly high proportion of the in-situ carcinoma does not calcify, so mammography cannot detect it. I said earlier that 20% of all diagnosed carcinoma are in-situ carcinomas. But we know that almost all carcinomas go through this stage - so what happens with the rest? We must assume that MRI will enable us to detect more carcinomas at this early stage, particularly the high-grade carcinoma.
‘Basically, unlike what was previously believed, MRI is superior to mammography also for the pre-invasive stages, the in-situ carcinoma. For the non high-grade in-situ carcinoma both procedures are complementary. For the high-grade in-situ carcinoma they are not complementary - MRI is clearly superior.
‘One of my favourite assumptions (but which cannot be proved) is that the perhaps 10% of DCIS that cannot be detected by MRI are not biologically relevant - because they are not preparing to invade and might never become invasive. For invasive growth, the DCIS requires vessels that deliver nutrients and oxygen. When those vessels are present MRI can detect the DCIS, so quite possibly we can see all those carcinomas that are preparing to invade. If we want to detect breast cancer at an early stage then, quite clearly, we want to detect it at the in-situ and early invasive stages. And we certainly want to find the high-grade carcinomas. If we know that the examination we currently use for early detection - mammography - can only find half of the invasive and intra-ductal carcinomas, then the logical consequence is obvious.
*Dr Kuhl is Professor of Radiology and Vice Chair at the Department of Radiology, and Director of the Division of Oncologic Imaging and Interventional Therapy at the University of Bonn.
Comments
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That certainly was my experience. I had a large amount of both intermediate and high grade DCIS. Mammography showed nothing until 3 tiny calcifications appeared years into the DCIS growth process. An MRI, however, lit up the DCIS like a Christmas tree and showed the extent of my disease. My surgeon agrees that we will do MRI's as well as mammos from now on to monitor my healthy breast.
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Same here. I had my mammogram in September, and they'd said it was okay. But at that appointment the mammo tech noticed my nipple a bit retracted...something I'd not noticed before. I went to my Dr the next week, who sent me to the breast surgeon, who sent me to the MRI that showed an extensive area of high grade DCIS. If that mammo tech had not mentioned that nipple retraction to me, I'd still be living my life with no idea I had cancer.
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Mammogram didn't show it for years, until it was too advanced. MRI showed a more extensive area involved, and that area proved invasive at the pathology after mastectomy - ILC and ICC (thing that the stereotactic biopsy hadn't shown as it was guided only by the DCIS spots shown by the mammogram).
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Mammography August 08- everything fine, without actually feeling a specific area, felt something different about left breast, went to primary doc Sept 08, he felt something at 10 o'clock, October 08, ultrasound - an enlarged duct at 10 o'clock. Dec 08, breast surgeon - could feel nothing but ordered ultrasound March 09 - enlarged duct now plugged and suspicious, April 09, core biopsy, May 09 Lumpectomy (DCIS grade 3). June-July 09 radiation. I asked the radiologist, if I had not pursued my funny feeling-despite the ok mammogram, whether the DCIS would have shown up on the mammogram which would have been done August 09. He said NOT NECESSARILY. I had an MRI post lumpectomy - pre-radiation - most concerned about other breast - nothing more showed on either breast . Just had a mammogram in October 09 everything good (but how can I trust it?) will have an annual MRI.
They are going to have to come up with a new screening technique which is more sensitive than mammograms, but less invasive and expensive than MRIs.
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Wow -- very interesting! Thanks for sharing! Now I'm eager to get a copy of my MRI's. (I had zillions of microcalcifications in my DCIS breast though. I gather from this article that that's because mine was grade 2 instead of grade 3?)
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Just got my path report yesterday, got an MRI, met with breast surgeon. She said there appeared to be more calcifications, but they appeared to be benign. No more info until we get the results from the MRI. Right now I'm just thinking "cut the whole thing OFF"!
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I ended up with an MRI, an US, and several mammos. The MRI didn't really see the calcs, the US saw them better. The radiologist said that because mine were at such an early stage, it is really hard to detect with an MRI or an US. Seems we get different information -- probably based on who is reading the pictures. I ended up with two spots about 4 inches apart, which now means a mastectomy rather than a lumpectomy.
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I sat next to the radiologist and looked at my MRI. The enhancing areas (DCIS) were obvious.
In my experience, mammo won't see it unless there are calcs but MRI can see it even w/o calcs.
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