Multimodality Imaging of Ductal Carcinoma In Situ

Purpose of Review: We aim to review the appearance of ductal carcinoma in situ (DCIS) across the spectrum of imaging modalities used in common clinical practice. Recent Findings: Changes in technology and clinical breast cancer screening patterns have impacted the imaging evaluation of DCIS. DCIS classically presents as asymptomatic calcifications in women undergoing screening mammography. The replacement of traditional 2D mammography with digital breast tomosynthesis has changed the typical appearance of screen-detected DCIS. Ultrasound is traditionally utilized to detect DCIS in women with clinical symptoms, but efforts to increase screening ultrasound rates for women with dense breasts makes it more important to identify the appearance of DCIS in asymptomatic women. Improvements in MRI technology have made MRI the most sensitive imaging modality to detect DCIS and define the extent of disease, which is increasingly important given greater utilization of MRI for high-risk screening and determination of extent of known disease. Finally, the emergence of active surveillance, or non-surgical management, for DCIS has increased the focus on presurgical identification of associated invasive cancer, with early results demonstrating promise via computer vision and deep learning approaches for this task. Summary: DCIS has a highly variable imaging appearance which is subject to changes in imaging technology and clinical management.

Duke Scholars

Author Lars Johannes L Grimm Radiology, Breast Imaging