Ductal Carcinoma in Situ: State-of-the-Art Review

被引:64
作者
Grimm, Lars J. [1 ]
Rahbar, Habib [4 ]
Abdelmalak, Monica [2 ]
Hall, Allison H. [2 ]
Ryser, Marc D. [3 ]
机构
[1] Duke Univ, Dept Radiol, 2301 Erwin Rd,Box 3808, Durham, NC 27710 USA
[2] Duke Univ, Dept Pathol, 2301 Erwin Rd,Box 3808, Durham, NC 27710 USA
[3] Duke Univ, Dept Populat Hlth Sci, 2301 Erwin Rd,Box 3808, Durham, NC 27710 USA
[4] Univ Washington, Dept Radiol, Seattle, WA 98195 USA
关键词
OCCULT INVASIVE DISEASE; BREAST-CANCER; ACTIVE SURVEILLANCE; LOW-RISK; LOCAL RECURRENCE; MAMMOGRAPHIC APPEARANCE; IMAGING FEATURES; NATURAL-HISTORY; FOLLOW-UP; MRI;
D O I
10.1148/radiol.211839
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery. (c) RSNA, 2021
引用
收藏
页码:246 / 255
页数:10
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