16. The role of mammography in predicting of histological grade of ductal carcinoma in situ
Main Article Content
Abstract
This study aimed to evaluate the role of mammography in predicting the histological grade of ductal carcinoma in situ (DCIS) of the breast. A cross-sectional descriptive study was conducted on 134 DCIS patients at the National Cancer Hospital from September 2019 to October 2023. The mean patient age was 50.8 years old. Histological grades 1, 2, and 3 accounted for 17.9%, 26.1%, and 56% of all cases, respectively. The presence of calcifications, fine-linear or fine-branched calcifications, and lobular distribution significantly increased the likelihood of high-grade DCIS, with odds ratios (OR) of 3.761, 8.444, and 3.455, respectively (p < 0.05). In contrast, the presence of mass and amorphous microcalcifications was associated with a higher probability of low-grade DCIS, with OR of 6.800 and 16.265, respectively (p < 0.05).
Article Details
Keywords
Mammography, tumor grade, DCIS
References
1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. May-Jun 2024; 74(3): 229-263. doi:10.3322/caac.21834.
2. Tan PH, Ellis I, Allison K, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology. Aug 2020; 77(2): 181-185. doi:10.1111/his.14091
3. Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. Journal of the National Cancer Institute. Feb 3 2010; 102(3): 170-8. doi:10.1093/jnci/djp482.
4. Solin LJ, Gray R, Hughes LL, et al. Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Nov 20 2015; 33(33): 3938-44. doi:10.1200/jco.2015.60.8588.
5. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. Nov 1991; 19(5): 403-10. doi:10.1111/j.1365-2559.1991.tb00229.x.
6. Sagara Y, Mallory MA, Wong S, et al. Survival Benefit of Breast Surgery for Low-Grade Ductal Carcinoma In Situ: A Population-Based Cohort Study. JAMA surgery. Aug 2015; 150(8): 739-45. doi:10.1001/jamasurg.2015.0876.
7. Kalwaniya DS, Gairola M, Gupta S, Pawan G. Ductal Carcinoma in Situ: A Detailed Review of Current Practices. Cureus. Apr 2023; 15(4): e37932. doi:10.7759/cureus.37932.
8. Winchester DP, Jeske JM, Goldschmidt RA. The diagnosis and management of ductal carcinoma in-situ of the breast. CA Cancer J Clin. May-Jun 2000; 50(3): 184-200. doi:10.3322/canjclin.50.3.184.
9. Hồng Quang L, Văn Đức N. Kết quả điều trị ung thư biểu mô tuyến vú thể nội ống tại Bệnh viện K. Tạp chí Y học Việt Nam. 06/21 2022; 514(2)doi:10.51298/vmj.v514i2.2639.
10. Đặng PT, Trần TL, Dương ĐH, Nguyễn DT. Nhận xét vai trò sinh thiết kim dưới hướng dẫn siêu âm trong chẩn đoán tính xâm nhập của ung thư tuyến vú. Tạp chí Y học Việt Nam. 02/24 2023; 523(1)doi:10.51298/vmj.v523i1.4452.
11. Schnitt SJ. Problematic issues in breast core needle biopsies. Modern Pathology. 2019/01/01/ 2019;32:71-76. doi:https://doi.org/10.1038/s41379-018-0137-0.
12. Ernster VL, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. Journal of the National Cancer Institute. Oct 16 2002; 94(20): 1546-54. doi:10.1093/jnci/94.20.1546.
13. Silverstein MJ, Lagios MD, Craig PH, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. Jun 1 1996; 77(11): 2267-74. doi:10.1002/(SICI)1097-0142(19960601)77:11<2267::AID-CNCR13>3.0.CO;2-V.
14. Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology. Feb 2022; 302(2): 246-255. doi:10.1148/radiol.211839.
15. Barreau B, de Mascarel I, Feuga C, et al. Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol. Apr 2005; 54(1): 55-61. doi:10.1016/j.ejrad.2004.11.019.
16. Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010; 2010(41): 139-41. doi:10.1093/jncimonographs/lgq027.
17. Fowler EE, Sellers TA, Lu B, Heine JJ. Breast Imaging Reporting and Data System (BI-RADS) breast composition descriptors: automated measurement development for full field digital mammography. Medical physics. Nov 2013; 40(11): 113502. doi:10.1118/1.4824319.
18. Ciatto S, Bianchi S, Vezzosi V. Mammographic appearance of calcifications as a predictor of intraductal carcinoma histologic subtype. European Radiology. 1994/02/01 1994; 4(1): 23-26. doi:10.1007/BF00177382.
19. Carlson KL, Helvie MA, Roubidoux MA, et al. Relationship between mammographic screening intervals and size and histology of ductal carcinoma in situ. AJR Am J Roentgenol. Feb 1999; 172(2): 313-7. doi:10.2214/ajr.172.2.9930774.
20. Stomper PC, Connolly JL, Meyer JE, Harris JR. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation. Radiology. Jul 1989; 172(1): 235-41. doi:10.1148/radiology.172.1.2544922.
21. Evans A, Pinder S, Wilson R, et al. Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. AJR Am J Roentgenol. Jun 1994; 162(6): 1307-11. doi:10.2214/ajr.162.6.8191988.
22. Chen PH, Ghosh ET, Slanetz PJ, Eisenberg RL. Segmental breast calcifications. AJR Am J Roentgenol. Nov 2012; 199(5): W532-42. doi:10.2214/AJR.11.8198.
23. Yamada T, Mori N, Watanabe M, et al. Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. Sep 2010; 30(5): 1183-98. doi:10.1148/rg.305095073.
24. Kong J, Liu X, Zhang X, Zou Y. The predictive value of calcification for the grading of ductal carcinoma in situ in Chinese patients. Medicine (Baltimore). Jul 10 2020; 99(28): e20847. doi:10.1097/MD.0000000000020847.
25. Yang WT, Tse GM. Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. Jan 2004; 182(1): 101-10. doi:10.2214/ajr.182.1.1820101.
26. Holland R, Hendriks JH. Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. Aug 1994; 11(3): 181-92.
27. Hofvind S, Iversen BF, Eriksen L, Styr BM, Kjellevold K, Kurz KD. Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol. Jun 1 2011; 52(5): 481-7. doi:10.1258/ar.2011.100357.
28. Rauch GM, Kuerer HM, Scoggins ME, et al. Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. Jun 2013; 139(3): 639-47. doi:10.1007/s10549-013-2598-7.
29. Oligane HC, Berg WA, Bandos AI, et al. Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy. 2018; 288 3: 671-679.
30. Rahbar H, Partridge SC, Demartini WB, et al. In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. May 2012; 263(2): 374-82. doi:10.1148/radiol.12111368.
31. Sprague BL, Coley RY, Lowry KP, et al. Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium. Radiology. Jun 2023; 307(5): e223142. doi:10.1148/radiol.223142.
2. Tan PH, Ellis I, Allison K, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology. Aug 2020; 77(2): 181-185. doi:10.1111/his.14091
3. Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. Journal of the National Cancer Institute. Feb 3 2010; 102(3): 170-8. doi:10.1093/jnci/djp482.
4. Solin LJ, Gray R, Hughes LL, et al. Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Nov 20 2015; 33(33): 3938-44. doi:10.1200/jco.2015.60.8588.
5. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. Nov 1991; 19(5): 403-10. doi:10.1111/j.1365-2559.1991.tb00229.x.
6. Sagara Y, Mallory MA, Wong S, et al. Survival Benefit of Breast Surgery for Low-Grade Ductal Carcinoma In Situ: A Population-Based Cohort Study. JAMA surgery. Aug 2015; 150(8): 739-45. doi:10.1001/jamasurg.2015.0876.
7. Kalwaniya DS, Gairola M, Gupta S, Pawan G. Ductal Carcinoma in Situ: A Detailed Review of Current Practices. Cureus. Apr 2023; 15(4): e37932. doi:10.7759/cureus.37932.
8. Winchester DP, Jeske JM, Goldschmidt RA. The diagnosis and management of ductal carcinoma in-situ of the breast. CA Cancer J Clin. May-Jun 2000; 50(3): 184-200. doi:10.3322/canjclin.50.3.184.
9. Hồng Quang L, Văn Đức N. Kết quả điều trị ung thư biểu mô tuyến vú thể nội ống tại Bệnh viện K. Tạp chí Y học Việt Nam. 06/21 2022; 514(2)doi:10.51298/vmj.v514i2.2639.
10. Đặng PT, Trần TL, Dương ĐH, Nguyễn DT. Nhận xét vai trò sinh thiết kim dưới hướng dẫn siêu âm trong chẩn đoán tính xâm nhập của ung thư tuyến vú. Tạp chí Y học Việt Nam. 02/24 2023; 523(1)doi:10.51298/vmj.v523i1.4452.
11. Schnitt SJ. Problematic issues in breast core needle biopsies. Modern Pathology. 2019/01/01/ 2019;32:71-76. doi:https://doi.org/10.1038/s41379-018-0137-0.
12. Ernster VL, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. Journal of the National Cancer Institute. Oct 16 2002; 94(20): 1546-54. doi:10.1093/jnci/94.20.1546.
13. Silverstein MJ, Lagios MD, Craig PH, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. Jun 1 1996; 77(11): 2267-74. doi:10.1002/(SICI)1097-0142(19960601)77:11<2267::AID-CNCR13>3.0.CO;2-V.
14. Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology. Feb 2022; 302(2): 246-255. doi:10.1148/radiol.211839.
15. Barreau B, de Mascarel I, Feuga C, et al. Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol. Apr 2005; 54(1): 55-61. doi:10.1016/j.ejrad.2004.11.019.
16. Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010; 2010(41): 139-41. doi:10.1093/jncimonographs/lgq027.
17. Fowler EE, Sellers TA, Lu B, Heine JJ. Breast Imaging Reporting and Data System (BI-RADS) breast composition descriptors: automated measurement development for full field digital mammography. Medical physics. Nov 2013; 40(11): 113502. doi:10.1118/1.4824319.
18. Ciatto S, Bianchi S, Vezzosi V. Mammographic appearance of calcifications as a predictor of intraductal carcinoma histologic subtype. European Radiology. 1994/02/01 1994; 4(1): 23-26. doi:10.1007/BF00177382.
19. Carlson KL, Helvie MA, Roubidoux MA, et al. Relationship between mammographic screening intervals and size and histology of ductal carcinoma in situ. AJR Am J Roentgenol. Feb 1999; 172(2): 313-7. doi:10.2214/ajr.172.2.9930774.
20. Stomper PC, Connolly JL, Meyer JE, Harris JR. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation. Radiology. Jul 1989; 172(1): 235-41. doi:10.1148/radiology.172.1.2544922.
21. Evans A, Pinder S, Wilson R, et al. Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. AJR Am J Roentgenol. Jun 1994; 162(6): 1307-11. doi:10.2214/ajr.162.6.8191988.
22. Chen PH, Ghosh ET, Slanetz PJ, Eisenberg RL. Segmental breast calcifications. AJR Am J Roentgenol. Nov 2012; 199(5): W532-42. doi:10.2214/AJR.11.8198.
23. Yamada T, Mori N, Watanabe M, et al. Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. Sep 2010; 30(5): 1183-98. doi:10.1148/rg.305095073.
24. Kong J, Liu X, Zhang X, Zou Y. The predictive value of calcification for the grading of ductal carcinoma in situ in Chinese patients. Medicine (Baltimore). Jul 10 2020; 99(28): e20847. doi:10.1097/MD.0000000000020847.
25. Yang WT, Tse GM. Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. Jan 2004; 182(1): 101-10. doi:10.2214/ajr.182.1.1820101.
26. Holland R, Hendriks JH. Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. Aug 1994; 11(3): 181-92.
27. Hofvind S, Iversen BF, Eriksen L, Styr BM, Kjellevold K, Kurz KD. Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol. Jun 1 2011; 52(5): 481-7. doi:10.1258/ar.2011.100357.
28. Rauch GM, Kuerer HM, Scoggins ME, et al. Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. Jun 2013; 139(3): 639-47. doi:10.1007/s10549-013-2598-7.
29. Oligane HC, Berg WA, Bandos AI, et al. Grouped Amorphous Calcifications at Mammography: Frequently Atypical but Rarely Associated with Aggressive Malignancy. 2018; 288 3: 671-679.
30. Rahbar H, Partridge SC, Demartini WB, et al. In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. May 2012; 263(2): 374-82. doi:10.1148/radiol.12111368.
31. Sprague BL, Coley RY, Lowry KP, et al. Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium. Radiology. Jun 2023; 307(5): e223142. doi:10.1148/radiol.223142.