New Perspective on DCIS Using MRI: Correlation of Tumor and Vessel Proliferation with MR Signal Enhancement

摘要

The purpose of our study was to determine whether MRI features could distinguish biologic characteristics of DCIS. We identified 100 patients at USCF who had a diagnosis of DCIS and underwent MRI scanning prior to definitive surgery. 66 scans were evaluable on PACS and characterized by enhancement patterns, density of lesion, extent of breast involved, dynamic pattern, and size. MRI enhancement characteristics were correlated with pathology characteristics (70 cases) and immunohistochemical markers of proliferation, angiogenesis, and inflammation to assess the value of MRI as a non-invasive, surrogate marker. 57 patients had sufficient tissue for immunohistochemistry analysis. Size, as measured by MRI and pathology, were significantly correlated (0.001). Considering the imprecise nature of measuring the physical size of DCIS lesions, the demonstrated correlation is remarkable, and certainly far better than mammography. We expected that markers of angiogenesis, proliferation, and inflammation would be distinguishable by MR. However, angiogenesis (CD34) did not correlate with any MRl characteristics, or with nuclear grade. In contrast, the inflammatory marker, CD68, strongly correlated with all of the DCIS markers known to be associated with bad outcomes (higher progression rates), including lesion size (on both MRl and pathology), extensive comedonecrosis, high nuclear grade, and the percent of breast involved on MRl (0.001), and MR size (0.01), and regional enhancement pattern. Interestingly, CD68 was also correlated with MRI density (0.001), the measure of a lesion's enhancement concentration developed specifically for this study. Ki67 was correlated with MR wash-out and enhancement patterns. The patterns of MRI enhancement suggest the type of DCIS present- very small focal masses were most likely to be ER positive, whereas regional/multi-regional had a lower ER score, higher grade, much higher CD68 count and extensive comedonecrosis.