Multimodel Imaging Analysis Of Breast Ductal Carcinoma In Situ Within Papilloma-background

Objective:To investigate the mammography,ultrasound and MRI features of ductal carcinoma in situ within papilloma-background(DCIS-WP)and ductal carcinoma in situ in general(DCIS-IG),and to provide imaging basis for clinical treatment.Methods:A retrospective analysis of 167 patients with DCIS-WP and DCIS-IG confirmed by pathology from January 2015 to May 2019 was conducted,including 50patients with DCIS-WP and 117 patients with DCIS-IG.All patients accepted mammography,ultrasound and MRI examinations before surgery.Mammography,ultrasound and MRI images were analyzed according to the American College of Radiology BI-RADS system(2013).On mammography,we mainly evaluate the lesion type,and analyze the morphology and distribution of calcification in patients with calcification.The features on ultrasound include the lesion type,the feature of lesion along the direction of the duct,vascularity,and multiple hypoechoic nodules feature.The features on MRI include the lesion type and the type of TIC,and evaluate the distribution,ductal ectasia sign,TIC curve,background of multiple papillomas,and internal enhancement of non mass lesions.We assigned the BI-RADS lesion category≥4B as accurate diagnosis.Diagnostic accuracy rate and detection rate on mammography,ultrasound,and MRI were analyzed.On the other hand,the consistency of preoperative puncture,intraoperative frozen section and postoperative paraffin section was also observed.Data were compared usingχ~2test,Fisher’s exact test was used if the sample size was smaller than 40 or the expected value was smaller than 1,P<0.05 was considered to indicate a statistically significant difference.Results:On mammography,43.3%(13/30)of DCIS-WP patients had calcification or calcification with asymmetry,10.0%(5/50)of them had suspicious malignant calcification.In DCIS-IG group,76.6%(85/111)showed calcification or calcification with asymmetry,57.3%(67/117)of them had suspicious malignant calcification.The detection rate of DCIS-WP and DCIS-IG were 60.0%and 94.9%,the diagnostic accuracy rate of them were 30.0%and 80.3%respectively on mammography(P<0.05).On ultrasound,26.0%(13/50)of DCIS-WP and 1.7%(2/117)of DCIS-IG showed multiple hypoechoic nodules.The detection rate of DCIS-WP and DCIS-IG were 100%and 23.1%(P<0.05).The diagnostic accuracy rate of them had no statistically significant difference.On MRI,56.0%(28/50)of DCIS-WP and 19.7%(23/117)of DCIS-IG showed ductal ectasia sign,52.0%(26/50)and 19.7%(23/117)of them had background of multiple papillomas respectively.DCIS-WP showed scattered rings in different sizes more frequently while DCIS-IG showed concentrated rings in uniformed size(P<0.05).The diagnostic accuracy rate and the detection rate of DCIS-WP and DCIS-IG on MRI had no statistically significant difference.The consistency of core needle biopsy,intraoperative frozen section and postoperative paraffin section of DCIS-WP and DCIS-IG were 34.7%(17/49)and 89.7%(104/116)respectively(P<0.05).Conclusion:DCIS-WP and DCIS-IG have different features on mammography and ultrasound.DCIS-WP is relatively common to be missed by mammography as it seldom show suspicious calcification while it is easier to be detected by ultrasound because it shows multiple hypoechoic nodules more frequently.On the contrary,mammography has more advantages in detecting DCIS-IG as many of DCIS-IG patients show typical malignant calcification while ultrasound is more likely to miss it.Combining mammography and ultrasound in breast cancer screening is beneficial to the detection of different types of breast DCIS.On MRI,DCIS-WP shows scattered rings in different sizes and had ductal ectasia and background of multiple papillomas more frequently,while DCIS-IG is more likely to show concentrated rings in uniformed size.MRI has great diagnostic efficacy for both types of DCIS and is helpful in differentiating them.The clinical treatment of patients indicated as DCIS-WP by multimodal imaging analysis is suggested to reduce puncture and intraoperative frozen section,and the further treatment should not be decided without the confirmation of paraffin section.