Non-mass versus mass-like ultrasound patterns in ductal carcinoma in situ: is there an association with high-risk histology?

D. S. Gunawardena, S. Burrows, D. B. Taylor

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Abstract

AIM: To review the ultrasound (US) patterns of pure ductal carcinoma in situ (DCIS) using a non-mass-like (NML) versus mass-like (ML) classification and to investigate histopathological associations. MATERIALS AND METHODS: The present study was a retrospective analysis of sonographically evident pure DCIS lesions detected in a mammographic (MG) screening programme over a 7-year period from 2008. All lesions had undergone US-guided 14 G core biopsies with no upgrades to invasive disease on surgical histopathology. Lesions that were three-dimensional with convex margins were classified as ML and all others as NML. ML lesions were subdivided into solid, cystic, or mixed, and NML lesions into ductal and non-ductal. Imaging and pathological characteristics of NML versus ML lesions were investigated using logistic regression. RESULTS: There were 78 lesions in 75 participants. NML lesions accounted for 45 (58%) lesions, comprising 27 (60%) ductal and 18 (40%) non-ductal subtypes. There were 33 (42%) ML lesions; the largest subgroup being solid (n=21, 64%). Significant associations between lesion type and lesion size on US (<15 versus ≥15 mm), presence of US and mammographic calcification and posterior shadowing on sonography were identified. NML lesions had fivefold higher odds (OR=5.41 95% confidence interval [CI]: 2.03, 14.39, p=0.001) to be high grade and sevenfold higher odds (OR=7 95% CI: 1.75, 27.99, p=0.006) to have comedo necrosis on histopathology. CONCLUSION: DCIS lesions can be successfully classified using ML and NML lesion descriptors and NML morphology on US is associated with histological features of “high-risk” DCIS.

Original languageEnglish
JournalClinical Radiology
DOIs
Publication statusE-pub ahead of print - 15 Nov 2019

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Carcinoma, Intraductal, Noninfiltrating
Histology
Confidence Intervals
Ultrasonography
Necrosis
Logistic Models
Biopsy

Cite this

@article{7a8e4b6c21e644bc92e6e7c25ad2a8f4,
title = "Non-mass versus mass-like ultrasound patterns in ductal carcinoma in situ: is there an association with high-risk histology?",
abstract = "AIM: To review the ultrasound (US) patterns of pure ductal carcinoma in situ (DCIS) using a non-mass-like (NML) versus mass-like (ML) classification and to investigate histopathological associations. MATERIALS AND METHODS: The present study was a retrospective analysis of sonographically evident pure DCIS lesions detected in a mammographic (MG) screening programme over a 7-year period from 2008. All lesions had undergone US-guided 14 G core biopsies with no upgrades to invasive disease on surgical histopathology. Lesions that were three-dimensional with convex margins were classified as ML and all others as NML. ML lesions were subdivided into solid, cystic, or mixed, and NML lesions into ductal and non-ductal. Imaging and pathological characteristics of NML versus ML lesions were investigated using logistic regression. RESULTS: There were 78 lesions in 75 participants. NML lesions accounted for 45 (58{\%}) lesions, comprising 27 (60{\%}) ductal and 18 (40{\%}) non-ductal subtypes. There were 33 (42{\%}) ML lesions; the largest subgroup being solid (n=21, 64{\%}). Significant associations between lesion type and lesion size on US (<15 versus ≥15 mm), presence of US and mammographic calcification and posterior shadowing on sonography were identified. NML lesions had fivefold higher odds (OR=5.41 95{\%} confidence interval [CI]: 2.03, 14.39, p=0.001) to be high grade and sevenfold higher odds (OR=7 95{\%} CI: 1.75, 27.99, p=0.006) to have comedo necrosis on histopathology. CONCLUSION: DCIS lesions can be successfully classified using ML and NML lesion descriptors and NML morphology on US is associated with histological features of “high-risk” DCIS.",
author = "Gunawardena, {D. S.} and S. Burrows and Taylor, {D. B.}",
year = "2019",
month = "11",
day = "15",
doi = "10.1016/j.crad.2019.10.009",
language = "English",
journal = "Clinical Radiology",
issn = "0009-9260",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Non-mass versus mass-like ultrasound patterns in ductal carcinoma in situ

T2 - is there an association with high-risk histology?

AU - Gunawardena, D. S.

AU - Burrows, S.

AU - Taylor, D. B.

PY - 2019/11/15

Y1 - 2019/11/15

N2 - AIM: To review the ultrasound (US) patterns of pure ductal carcinoma in situ (DCIS) using a non-mass-like (NML) versus mass-like (ML) classification and to investigate histopathological associations. MATERIALS AND METHODS: The present study was a retrospective analysis of sonographically evident pure DCIS lesions detected in a mammographic (MG) screening programme over a 7-year period from 2008. All lesions had undergone US-guided 14 G core biopsies with no upgrades to invasive disease on surgical histopathology. Lesions that were three-dimensional with convex margins were classified as ML and all others as NML. ML lesions were subdivided into solid, cystic, or mixed, and NML lesions into ductal and non-ductal. Imaging and pathological characteristics of NML versus ML lesions were investigated using logistic regression. RESULTS: There were 78 lesions in 75 participants. NML lesions accounted for 45 (58%) lesions, comprising 27 (60%) ductal and 18 (40%) non-ductal subtypes. There were 33 (42%) ML lesions; the largest subgroup being solid (n=21, 64%). Significant associations between lesion type and lesion size on US (<15 versus ≥15 mm), presence of US and mammographic calcification and posterior shadowing on sonography were identified. NML lesions had fivefold higher odds (OR=5.41 95% confidence interval [CI]: 2.03, 14.39, p=0.001) to be high grade and sevenfold higher odds (OR=7 95% CI: 1.75, 27.99, p=0.006) to have comedo necrosis on histopathology. CONCLUSION: DCIS lesions can be successfully classified using ML and NML lesion descriptors and NML morphology on US is associated with histological features of “high-risk” DCIS.

AB - AIM: To review the ultrasound (US) patterns of pure ductal carcinoma in situ (DCIS) using a non-mass-like (NML) versus mass-like (ML) classification and to investigate histopathological associations. MATERIALS AND METHODS: The present study was a retrospective analysis of sonographically evident pure DCIS lesions detected in a mammographic (MG) screening programme over a 7-year period from 2008. All lesions had undergone US-guided 14 G core biopsies with no upgrades to invasive disease on surgical histopathology. Lesions that were three-dimensional with convex margins were classified as ML and all others as NML. ML lesions were subdivided into solid, cystic, or mixed, and NML lesions into ductal and non-ductal. Imaging and pathological characteristics of NML versus ML lesions were investigated using logistic regression. RESULTS: There were 78 lesions in 75 participants. NML lesions accounted for 45 (58%) lesions, comprising 27 (60%) ductal and 18 (40%) non-ductal subtypes. There were 33 (42%) ML lesions; the largest subgroup being solid (n=21, 64%). Significant associations between lesion type and lesion size on US (<15 versus ≥15 mm), presence of US and mammographic calcification and posterior shadowing on sonography were identified. NML lesions had fivefold higher odds (OR=5.41 95% confidence interval [CI]: 2.03, 14.39, p=0.001) to be high grade and sevenfold higher odds (OR=7 95% CI: 1.75, 27.99, p=0.006) to have comedo necrosis on histopathology. CONCLUSION: DCIS lesions can be successfully classified using ML and NML lesion descriptors and NML morphology on US is associated with histological features of “high-risk” DCIS.

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U2 - 10.1016/j.crad.2019.10.009

DO - 10.1016/j.crad.2019.10.009

M3 - Article

JO - Clinical Radiology

JF - Clinical Radiology

SN - 0009-9260

ER -