The Diagnostic Value Of Multi-modality Technology In Ductal Carcinoma In Situ

Objective:To collect the mammography and dynamic contrast-enhanced MRI（DCE-MRI）data of ductal carcino ma in situ（DCIS）and invasive breast cancer（IBC）.We analyzed and compared the imaging and DCE-MRI quantitative parameters of DCIS and IBC to obtain the characters and diagnistic value of MRI multiple parameters of DCIS,in order to improve the preoperative diagnostic accuracy of MRI for DCIS.Methods:Retrospective analysis of 67 patients（ages 24 to 82 years old,mean 51.6±13.3years）of DCIS patients who were confirmed by pathology and performed preoperative mammography and DCE-MRI examinations from January 2016 to October 2017 in our hospital;At the same time,the clinical and imaging data of 101 IBC patients（ages 28 to 77years old,average 51.5±10.9 years old）were collected to as control group according to the enrollment criteria.All patients underwent routine Mammography X-ray scans,and MRI Routine Breast Scans and DCE-MRI scans by Siemens breast X-ray camera and German Siemens 3.0T Magnetom Verio MRI Scanner.The X-ray,MRI grade,DCE-MRI features,and time-intensity curve（TIC）of the lesions were analyze according to the X-ray and MRI standards of the Breast Imaging Reporting and Data System（BI-RADS）updated by the American Radiological Society（ACR）in 2013.The post-processing software（O mni-K inetics）was used to measure perfusion parameters（Ktrans and Kep）.The statistical analysis was performed by SPSS 19.0 software.The Chi-square test or Fisher’s exact probability method was used for categorical data;two independent sample t-tests or Mann-Whitney U test was used for continuous data;The receiver operating characteristic（ROC）curves were used to assess the optimal threshold and diagnostic efficacy of quantitative parameters（Ktrans and Kep）.P<0.05 was considered statistically significant.Result1.Diagnostic accuracy:According to the BI-RADS standard,the diagnostic accuracy of mammographic X-ray and MRI in 67 cases of DCIS was 68.7%and 86.6%,respectively;the diagnostic accuracy of mammographic X-ray and MRI in 101 cases of IBC was 76.2%and93.1%,respectively;the diagnostic accuracy of breast MRI and X-ray in DCIS and IBC were statistically significant（p<0.05）.2.DCE-MRI morphological characteristics:a total of 56 cases（83.6%）were non-mass-like enhancement in DC IS 67 cases,18 cases（32.1%）were linear distribution,and 21 cases（37.5%）were segmental distribution.Most of the internal enhancement features were heterogeneous enhancement（27 cases,48.2%）and clustered ring enhancement（23 cases,41.0%,17 of 23 cases appeared in the segmental distribution）.In 101 cases of IBC,a total of88 cases（87.1%）of mass like enhancement,62 cases（70.1%）were irregular,62 cases（69.7%）were not circumscribed.In term of internal enhancement,23 cases（25.8%）showed homogeneous enhancement,49 cases（55.1%）showed heterogeneous enhance ment and 17cases（19.1%）showed rim enhancement.3.TIC type:there were 21 type I（31.3%）,39 type II（58.2%）,and 7 type III（10.5%）in 67DCIS cases;there were 13 type I（12.9%）,59 type II（58.4%）and 29 type III（28.7%）in 101IBC cases.There was a statistically significant difference in the TIC type between the DCIS group and the IBC group（P<0.05）.4.Quantitative perfusion parameters K^{t rans} value:The mean K^{t rans} value in IBC group was significantly higher than DCIS group（P<0.05）,but there was no significant difference in K_epp value in two groups（P>0.05）.ROC curve analysis showed that the optimal threshold values of Ktrans for identifying DCIS and IBC were 0.542/min（sensitivity 85.1%,specificity 70.1%,AUC 0.796）.Conclusion:1.DCIS were characterized by segmental distribution and linear distribution of non-tumor-like enhancement in DC E-MRI.C lustered ring enhancement was a characteristic internal enhancement of DCIS.IBC often showed mass-like enhancement,and have irregular shape and not circumscribed.The internal enhancement of IBC could be homogeneous,heterogeneous,or rim enhancement in DCE-MRI.2.The TIC type is significant for the diagnosis and differential diagnosis of DCIS and IBC,but its evaluation weight is less than the morphological characteristics.3.It is helpful for the value of K^{t rans} contributes to the differential diagnosis of DCIS and IBC,and has certain diagnostic efficacy.4.Although the diagnostic sensitivity of DCE-MRI to DCIS is higher than that X-ray,it is not sensitive for calcification.In practical applications,closely combined the morphological characteristics,TIC type,and quantitative parameters of DCIS with X-ray to make a comprehensive evaluation would improve the level of diagnosis accuracy of DCIS.