Ductal carcinoma in situ on digital mammography versus digital breast tomosynthesis: rates and predictors of pathologic upgrade

Abstract

Objectives

To compare upgrade rates of ductal carcinoma in situ (DCIS) on digital mammography (DM) versus digital breast tomosynthesis (DBT) and identify patient, imaging, and pathological features associated with upgrade risk.

Methods

A retrospective review was performed of 318 women (mean 59 years, range 37–89) with screening-detected DCIS from 2007 to 2011 (DM group) and from 2013 to 2016 (DBT group). Comparisons made between DM and DBT groups using the unpaired t test and chi-square test include detection rates of DCIS, upgrade rates to invasive cancer, and pathological features of DCIS and upgraded cases. Patient, imaging, and pathological features associated with upgrade were also determined. P values < 0.05 were considered significant.

Results

There was no significant difference in detection rates of DCIS between DM and DBT groups (0.9 versus 1.0 per 1000 examinations, p = 0.45). Upgrade rates of DCIS to invasive cancer in DM and DBT groups were similar (17.3% versus 16.8%, p = 0.90), despite significant differences in pathological features of DCIS between DM and DBT groups (including nuclear grade, comedonecrosis, and progesterone receptor status [p ≤ 0.01]). Among upgraded cases, a higher proportion were high-grade invasive cancers with DBT (36.7% versus 9.5%, p = 0.03). In both groups, ultrasound-guided (versus stereotactic) biopsy was associated with higher upgrade risk (p ≤ 0.03).

Conclusions

There was no significant difference in detection rates or upgrade rates of DCIS on DM versus DBT; however, upgraded cases were more likely to be high grade with DBT, suggesting possible differences in tumor biology between cancers with DM and DBT. In both DM and DBT groups, biopsy modality was associated with upgrade risk.

Key Points

• Detection rates and upgrade rates of ductal carcinoma in situ (DCIS) on digital mammography (DM) versus digital breast tomosynthesis (DBT) are similar.

• A higher proportion of upgraded cases were high-grade invasive cancers with DBT than DM, suggesting possible differences in tumor biology between cancers that are detected with DM and DBT.

• With both DM and DBT, ultrasound-guided biopsy (versus stereotactic biopsy) was associated with a higher risk of upgrade.

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Fig. 1

Abbreviations

DBT:

Digital breast tomosynthesis

DCIS:

Ductal carcinoma in situ

DM:

Digital mammography

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

PR:

Progesterone receptor

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Acknowledgments

This abstract was submitted for oral presentation at the American Roentgen Ray Society (ARRS) Annual Meeting (Chicago, IL, May 2020). Dr. Geunwon Kim was awarded the ARRS Melissa Rosado de Christenson Award.

Funding

This work was supported by the National Cancer Institute (K08CA241365, PI: Dr. Manisha Bahl), the Agfa HealthCare/Radiological Society of North America (RSNA) Research Scholar Grant (PI: Dr. Manisha Bahl), and the Electronic Space Systems Corporation (ESSCO)-MGH Breast Cancer Research Fund (PI: Dr. Manisha Bahl and Dr. Tawakalitu O. Oseni). The sponsors had no involvement in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report; or, in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any other organizations listed above.

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Correspondence to Manisha Bahl.

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Guarantor

The scientific guarantor of this publication is Manisha Bahl, MD, MPH.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Study subjects or cohorts overlap

We have submitted or previously published manuscripts in which there is overlap of patients with this study:

  • Noncalcified ductal carcinoma in situ (DCIS): rate and predictors of upgrade to invasive carcinoma (published in Academic Radiology). In this published study, we report on 53 of the patients included in the current study. The study focuses on the upgrade rates of noncalcified DCIS detected on screening and diagnostic mammography and features associated with upgrade risk.

  • Do eligibility criteria for ductal carcinoma in situ (DCIS) active surveillance trials identify patients at low risk for upgrade to invasive carcinoma? (published in Annals of Surgical Oncology). In this published study, we report on 858 patients, 318 of whom are included in the current study. The purpose of the study is to determine upgrade rates of DCIS at needle biopsy to invasive carcinoma at surgery among women who meet eligibility criteria for active surveillance trials.

  • Breast cancer characteristics associated with 2D digital mammography versus digital breast tomosynthesis for screening-detected and interval cancers (published in Radiology). In this published study, we report on 948 breast cancers (January 2009–February 2011 and January 2013–February 2015), 184 of which are included in the current study. The purpose of the study is to compare the rates and tumor characteristics of screening-detected and interval cancers with digital mammography (DM) versus digital breast tomosynthesis (DBT).

    We believe that the current manuscript is distinct with regard to its objectives, materials and methods, results, and conclusions. In this study, we compare upgrade rates of DCIS on DM versus DBT and identify features that are associated with upgrade risk. There are no published studies, to our knowledge, on upgrade rates of DCIS, characteristics of the upgraded cancers, or predictors of upgrade in the modern era of DBT.

Methodology

• retrospective

• observational

• performed at one institution

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Kim, G., Mikhael, P.G., Oseni, T.O. et al. Ductal carcinoma in situ on digital mammography versus digital breast tomosynthesis: rates and predictors of pathologic upgrade. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-07021-2

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Keywords

  • Breast cancer
  • Digital breast tomosynthesis
  • Digital mammography
  • Ductal carcinoma in situ