Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment.

Published

Journal Article (Review)

Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.

Full Text

Duke Authors

Cited Authors

  • Shehata, M; Grimm, L; Ballantyne, N; Lourenco, A; Demello, LR; Kilgore, MR; Rahbar, H

Published Date

  • September 2019

Published In

  • J Breast Imaging

Volume / Issue

  • 1 / 3

Start / End Page

  • 166 - 176

PubMed ID

  • 31538141

Pubmed Central ID

  • 31538141

Electronic International Standard Serial Number (EISSN)

  • 2631-6129

Digital Object Identifier (DOI)

  • 10.1093/jbi/wbz039

Language

  • eng

Conference Location

  • United States