Breast Oncology: Techniques, Indications, and Interpretation by Samantha L. Heller & Linda Moy

Author:Samantha L. Heller & Linda Moy
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Fig. 9.6High grade DCIS in a 38 year old female with new diagnosis of DCIS. Post-contrast MIP image demonstrates an oval mass with irregular margins and a heterogeneous internal enhancement pattern in the slightly outer right breast

The least common morphologic appearance of DCIS is a focus [36–38]. A focus is defined as a lesion <5 mm, which is too small to further characterize (Fig. 9.7) [39]. The new BI-RADS edition has removed the term foci from the lexicon [39]. Rosen et al. found that pure DCIS manifests as a focus in 12.5 % of cases while 3.0 % of invasive carcinomas manifest as a focus [38]. Van Goethem et al. found that a focus was seen in 20 % of DCIS cases versus 2.8 % invasive cancers [44]. Factors suggesting that a focus is malignant on MRI include: no T2 hyperintensity, lack of fatty hilum, washout kinetics, new or enlarging in size. Signs of benignity of a focus include: T2 hyperintensity, presence of a fatty hilum, persistent kinetics, and stability [39].

Fig. 9.7Intermediate-grade DCIS in a 44 year old woman with negative mammographic findings who underwent screening MR imaging because of a strong family history of premenopausal breast cancer. Sagittal postcontrast subtraction image demonstrates a 4 mm focus that demonstrated type 3 (washout) kinetics (Reprinted with permission from Greenwood et al. [43], with permission from Radiology Society of North America (RSNA®))

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