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Underestimation of DCIS at MRI-Guided Vacuum-Assisted Breast Biopsy

Jung-min Lee1, Jennifer B. Kaplan1, Melissa P. Murray2, Marzena Mazur-Grbec1,3, Tade Tadic1,4, Damir Stimac1,5 and Laura Liberman1

1 Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
2 Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
3 Present address: Department of Radiology, Clinical Hospital Rijeka, Rijeka, Croatia.
4 Present address: Department for Diagnostic and Interventional Radiology, Clinic Hospital Split, Split, Croatia.
5 Present address: Department of Radiology, University Hospital Osijek, Osijek, Croatia.


Figure 1
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  		Fig. 1A —46-year-old asymptomatic woman, 5 years after left breast lumpectomy for node-negative, subcentimeter invasive ductal carcinoma and ductal carcinoma in situ (DCIS), presents for high-risk screening MRI with normal mammogram and normal physical examination. Sagittal fat-suppressed image of right breast after injection of IV gadolinium during bilateral breast MRI shows clumped, segmental enhancement spanning 8 cm (arrows), extending from nipple to posterior third of breast.

 

Figure 2
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  		Fig. 1B —46-year-old asymptomatic woman, 5 years after left breast lumpectomy for node-negative, subcentimeter invasive ductal carcinoma and ductal carcinoma in situ (DCIS), presents for high-risk screening MRI with normal mammogram and normal physical examination. Sagittal fat-suppressed image from MRI of right breast performed immediately before biopsy again shows extensive segmental enhancement (arrows).

 

Figure 3
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  		Fig. 1C —46-year-old asymptomatic woman, 5 years after left breast lumpectomy for node-negative, subcentimeter invasive ductal carcinoma and ductal carcinoma in situ (DCIS), presents for high-risk screening MRI with normal mammogram and normal physical examination. Sagittal fat-suppressed image from MRI of right breast obtained immediately after completion of tissue acquisition at MRI-guided vacuum-assisted biopsy shows low-signal artifact from biopsy obturator (arrow) in hematoma-filled biopsy cavity within segmental enhancement.

 

Figure 4
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  		Fig. 1D —46-year-old asymptomatic woman, 5 years after left breast lumpectomy for node-negative, subcentimeter invasive ductal carcinoma and ductal carcinoma in situ (DCIS), presents for high-risk screening MRI with normal mammogram and normal physical examination. Histologic analysis of vacuum-assisted biopsy specimen shows DCIS with micropapillary architecture, intermediate nuclear grade, and necrosis. (H and E, x100)

 

Figure 5
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  		Fig. 1E —46-year-old asymptomatic woman, 5 years after left breast lumpectomy for node-negative, subcentimeter invasive ductal carcinoma and ductal carcinoma in situ (DCIS), presents for high-risk screening MRI with normal mammogram and normal physical examination. At mastectomy, histologic analysis yielded DCIS with microinvasion. E shows invasive carcinoma (arrow), measuring less than 1 mm, surrounded by DCIS. F shows invasive glands (arrow) in stroma adjacent to DCIS. (E, H and E, x100; F, H and E, x200)

 

Figure 6
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  		Fig. 1F —46-year-old asymptomatic woman, 5 years after left breast lumpectomy for node-negative, subcentimeter invasive ductal carcinoma and ductal carcinoma in situ (DCIS), presents for high-risk screening MRI with normal mammogram and normal physical examination. At mastectomy, histologic analysis yielded DCIS with microinvasion. E shows invasive carcinoma (arrow), measuring less than 1 mm, surrounded by DCIS. F shows invasive glands (arrow) in stroma adjacent to DCIS. (E, H and E, x100; F, H and E, x200)

 

Figure 7
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  		Fig. 2A —60-year-old woman with history of left mastectomy presents for follow-up MRI examination of right breast with normal mammogram and normal physical examination. Sagittal fat-suppressed image of right breast after injection of IV gadolinium shows 0.5-cm irregular mass at 12-o'clock position (arrow) that is new from prior study.

 

Figure 8
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  		Fig. 2B —60-year-old woman with history of left mastectomy presents for follow-up MRI examination of right breast with normal mammogram and normal physical examination. Sagittal fat-suppressed image of right breast after contrast injection immediately before biopsy confirms presence of mass (arrow).

 

Figure 9
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  		Fig. 2C —60-year-old woman with history of left mastectomy presents for follow-up MRI examination of right breast with normal mammogram and normal physical examination. Sagittal fat-suppressed image of right breast immediately after 9-gauge MRI-guided vacuum-assisted shows obturator (arrow) in high-signal hematoma obscuring biopsy site.

 

Figure 10
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  		Fig. 2D —60-year-old woman with history of left mastectomy presents for follow-up MRI examination of right breast with normal mammogram and normal physical examination. Histologic analysis of vacuum-assisted breast biopsy specimen shows ductal carcinoma in situ (DCIS) with solid architecture, intermediate nuclear grade, and central mucin. (H and E, x40)

 

Figure 11
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  		Fig. 2E —60-year-old woman with history of left mastectomy presents for follow-up MRI examination of right breast with normal mammogram and normal physical examination. Histologic analysis of lumpectomy specimen shows invasive ductal carcinoma and small glands (arrow) in pools of mucin dissecting through stroma, measuring 0.3 cm, in background of DCIS. (H and E, x100)

 

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