Breast DCE-MRI morphological features and semi-quantitative parameters associated with upgrade to invasive carcinoma in biopsyproven DCIS

Vladimir Urban; Zorica Milosevic; Zoran Bukumiric; Katarina Obradovic; Nina Adzic; Dragana Pavlovic-Stankovic; Ivana Petkovic; Ivana Sovic; Irena Jovanic; Igor Spurnic

doi:10.2478/raon-2026-0043

.blurhash-client-img { display: none !important; }

Breast DCE-MRI morphological features and semi-quantitative parameters associated with upgrade to invasive carcinoma in biopsyproven DCIS

Radiology and Oncology

Volume 60 (2026): Issue 3 (September 2026)

By: Vladimir Urban, Zorica Milosevic, Zoran Bukumiric, Katarina Obradovic, Nina Adzic, Dragana Pavlovic-Stankovic, Ivana Petkovic, Ivana Sovic, Irena Jovanic and Igor Spurnic

Open Access

|Sep 2026

Abstract

Background

The aim of this study was to identify imaging predictors of upgrade to invasive carcinoma (IC) in patients with biopsy-proven ductal carcinoma in situ (DCIS) based on morphological features and semi-quantitative parameters derived from dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI).

Patients and methods

Ninety consecutive patients with biopsy-proven DCIS who had positive findings on standard full-protocol breast DCE-MRI and subsequently underwent surgical excision with final postoperative histopathological diagnosis were included. Patients with final postoperative IC were compared with those without IC. Morphological features (lesion type, size, multifocality/multicentricity, T2-weighted (T2W) and turbo inversion recovery magnitude [TIRM] characteristics) and semi-quantitative parameters (wash-in, peak enhancement, delayed phase of the timeintensity curve [TIC], time to peak [TTP], and positive enhancement integral [PEI]) were analyzed.

Results

Fifty-five patients (61.1%) had no IC, while 35 patients (38.9%) had IC on final histopathology. Patients with IC more frequently demonstrated non-mass enhancement (NME) combined with a mass, larger lesion size, multifocal or multicentric disease, T2W/TIRM hyperintensity, fast wash-in, higher peak enhancement, plateau and washout TIC patterns, higher PEI, and shorter TTP. Multivariate analysis identified NME combined with a mass, delayed-phase TIC characteristics, and TIRM hyperintensity as independent predictors of IC.

Conclusions

Our study confirmed that prediction models incorporating breast DCE-MRI morphological features and semi-quantitative parameters can stratify patients with biopsy-proven DCIS by their probability of upgrade to IC. TIRM hyperintensity emerged as one of three independent predictors of IC and, to the best of our knowledge, has not been previously reported in this context.

References

Tomlinson-Hansen SE, Khan M, Cassaro S. Breast ductal carcinoma in situ. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025. PMID: 33620843
Search in Google Scholar Back to article
Jatoi I, Shaaban AM, Jou E, Benson JR. The biology and management of ductal carcinoma in situ of the breast. Curr Probl Surg 2023; 60: 101361. doi: 10.1016/j.cpsurg.2023.101361
Open DOI Search in Google Scholar Back to article
Barreau B, de Mascarel I, Feuga C, MacGrogan G, Dilhuydy MH, Picot V, et al. Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol 2005; 54: 55-61. doi: 10.1016/j.ejrad.2004.11.019
Open DOI Search in Google Scholar Back to article
Raza S, Vallejo M, Chikarmane SA, Birdwell RL. Pure ductal carcinoma in situ: a range of MRI features. AJR Am J Roentgenol 2008; 191: 689-99. doi: 10.2214/AJR.07.3779
Open DOI Search in Google Scholar Back to article
Wisner DJ, Hwang ES, Chang CB, Tso HH, Joe BN, Lessing JN, et al. Features of occult invasion in biopsy-proven DCIS at breast MRI. Breast J 2013; 19: 650-8. doi: 10.1111/tbj.12201
Open DOI Search in Google Scholar Back to article
Menell JH, Morris EA, Dershaw DD, Abramson AF, Brogi E, Liberman L. Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J 2005; 11: 382-90. doi: 10.1111/j.1075-122X.2005.00121.x
Open DOI Search in Google Scholar Back to article
Kuhl CK, Schrading S, Bieling HB, Wardelmann E, Leutner CC, Koenig R, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 2007; 370: 485-92. doi: 10.1016/S0140-6736(07)61232-X
Open DOI Search in Google Scholar Back to article
Bluemke DA, Gatsonis CA, Chen MH, DeAngelis GA, DeBruhl N, Harms S, et al. Magnetic resonance imaging of the breast prior to biopsy. JAMA 2004; 292: 2735-42. doi: 10.1001/jama.292.22.2735
Open DOI Search in Google Scholar Back to article
Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004; 233: 830-49. doi: 10.1148/radiol.2333031484
Open DOI Search in Google Scholar Back to article
Takada K, Kashiwagi S, Asano Y, Goto W, Morisaki T, Takahashi K, et al. Factors predictive of invasive ductal carcinoma in cases preoperatively diagnosed as ductal carcinoma in situ. BMC Cancer 2020; 20: 513. doi: 10.1186/s12885-020-07001-1
Open DOI Search in Google Scholar Back to article
Park M, Kim EK, Kim MJ, Moon HJ. Preoperative prediction of ductal carcinoma in situ underestimation of the breast using dynamic contrast enhanced and diffusion-weighted imaging. J Korean Soc Magn Reson Med 2013; 17: 101-9. doi: 10.13104/jksmrm.2013.17.2.101
Open DOI Search in Google Scholar Back to article
Miceli R, Gao Y, Qian K, Heller SL. Predicting upgrade of ductal carcinoma in situ to invasive breast cancer at surgery with ultrafast imaging. AJR Am J Roentgenol 2023; 221: 34-43. doi: 10.2214/AJR.22.28698
Open DOI Search in Google Scholar Back to article
Dillon MF, McDermott EW, Quinn CM, O’Doherty A, O’Higgins N, Hill AD. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol 2006; 93: 559-63. doi: 10.1002/jso.20445
Open DOI Search in Google Scholar Back to article
Yoon GY, Choi WJ, Cha JH, Shin HJ, Chae EY, Kim HH. The role of MRI and clinicopathologic features in predicting the invasive component of biopsyconfirmed ductal carcinoma in situ. BMC Med Imaging 2020; 20: 95. doi: 10.1186/s12880-020-00494-z
Open DOI Search in Google Scholar Back to article
Lee CW, Wu HK, Lai HW, Wu WP, Chen ST, Chen DR, et al. Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components. Eur J Radiol 2016; 85: 780-9. doi: 10.1016/j.ejrad.2015.12.027
Open DOI Search in Google Scholar Back to article
Lee KH, Han JW, Kim EY, Yun JS, Park YL, Park CH. Predictive factors for the presence of invasive components in patients diagnosed with ductal carcinoma in situ based on preoperative biopsy. BMC Cancer 2019; 19: 1201. doi: 10.1186/s12885-019-6417-3
Open DOI Search in Google Scholar Back to article
Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 2011; 260: 119-28. doi: 10.1148/radiol.11102368
Open DOI Search in Google Scholar Back to article
Ko MS, Kim SH, Kang BJ, Choi BG, Song BJ, Cha ES, et al. A method to quantify breast MRI for predicting tumor invasion in patients with preoperative biopsy-proven ductal carcinoma in situ (DCIS). J Korean Soc Magn Reson Med 2013; 17: 73-82. doi: 10.13104/jksmrm.2013.17.2.73
Open DOI Search in Google Scholar Back to article
Park AY, Gweon HM, Son EJ, Yoo M, Kim JA, Youk JH. Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: preoperative predictors of invasive breast cancer. Eur J Radiol 2014; 83: 654-9. doi: 10.1016/j.ejrad.2014.01.010
Open DOI Search in Google Scholar Back to article
Goto M, Yuen S, Akazawa K, Nishida K, Konishi E, Kajihara M, et al. The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy. Eur Radiol 2012; 22: 1255-64. doi: 10.1007/s00330-011-2357-2
Open DOI Search in Google Scholar Back to article
Deurloo EE, Sriram JD, Teertstra HJ, Loo CE, Wesseling J, Rutgers EJ, et al. MRI of the breast in patients with DCIS to exclude the presence of invasive disease. Eur Radiol 2012; 22: 1504-11. doi: 10.1007/s00330-012-2394-5
Open DOI Search in Google Scholar Back to article
Nadrljanski M, Maksimovic R, Plesinac-Karapandzic V, Nikitovic M, Markovic-Vasiljkovic B, Milosevic Z. Positive enhancement integral values in dynamic contrast enhanced magnetic resonance imaging of breast carcinoma: ductal carcinoma in situ vs. invasive ductal carcinoma. Eur J Radiol 2014; 83: 1363-7. doi: 10.1016/j.ejrad.2014.05.006
Open DOI Search in Google Scholar Back to article
D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA, Creech WE, Butler PF, et al. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. 5^th ed. Reston, VA: American College of Radiology; 2013
Search in Google Scholar Back to article
Verma S, Turkbey B, Muradyan N, Rajesh A, Cornud F, Haider MA, et al. Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. AJR Am J Roentgenol 2012; 198: 1277-88. doi: 10.2214/AJR.12.8510
Open DOI Search in Google Scholar Back to article
Khiat A, Gianfelice D, Amara M, Boulanger Y. Influence of post-treatment delay on the evaluation of the response to focused ultrasound surgery of breast cancer by dynamic contrast enhanced MRI. Br J Radiol 2006; 79: 308-14. doi: 10.1259/bjr/23046051
Open DOI Search in Google Scholar Back to article
Gelezhe PB, Blokhin IA, Marapov DI, Morozov SP. Quantitative parameters of MRI and ¹⁸F-FDG PET/CT in the prediction of breast cancer prognosis and molecular type: an original study. Am J Nucl Med Mol Imaging 2020; 10: 279-92. PMID: 33329930
Search in Google Scholar Back to article
Marcotte-Bloch C, Balu-Maestro C, Chamorey E, Ettore F, Raoust I, Flipo B, et al. MRI for the size assessment of pure ductal carcinoma in situ (DCIS): a prospective study of 33 patients. Eur J Radiol 2011; 77: 462-7. doi: 10.1016/j.ejrad.2009.09.003
Open DOI Search in Google Scholar Back to article
Greenwood HI, Heller SL, Kim S, Sigmund EE, Shaylor SD, Moy L. Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics 2013; 33: 1569-88. doi: 10.1148/rg.336125055
Open DOI Search in Google Scholar Back to article
Kuhl CK. Why do purely intraductal cancers enhance on breast MR images? Radiology 2009; 253: 281-3. doi: 10.1148/radiol.2532091401
Open DOI Search in Google Scholar Back to article
Newstead GM. MR imaging of ductal carcinoma in situ. Magn Reson Imaging Clin N Am 2010; 18: 225-40. doi: 10.1016/j.mric.2010.02.004
Open DOI Search in Google Scholar Back to article
Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium based contrast material. Radiology 2014; 270: 834-41. doi: 10.1148/radiol.13131669
Open DOI Search in Google Scholar Back to article
Milosevic Z, Bogdanovic D. Breast imaging and percutaneous interventional procedures. In: Dzodic R, editor. Guidelines of Good Clinical Practice for the Diagnosis and Treatment of Breast Cancer [Serbian]. Belgrade: Ministry of Health of the Republic of Serbia; 2013. Available at: http://www.azus.gov.rs. Accessed 25 Dec 2025
Search in Google Scholar Back to article
Moloney B, Li X, Hirano M, Saad Eddin A, Lim JY, Biswas D, et al. Initial experience in implementing quantitative DCE-MRI to predict breast cancer therapy response in a multi-center and multi-vendor platform setting. Front Oncol 2024; 14: 1395502. doi: 10.3389/fonc.2024.1395502
Open DOI Search in Google Scholar Back to article
Ochoa-Albiztegui RE, Sevilimedu V, Horvat JV, Thakur SB, Helbich TH, Trattnig S, et al. Pharmacokinetic analysis of dynamic contrast-enhanced magnetic resonance imaging at 7T for breast cancer diagnosis and characterization. Cancers 2020; 12: 3763. doi: 10.3390/cancers12123763
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/raon-2026-0043 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

Journal RSS Feed

Language: English

Page range: 356 - 366

Submitted on: Feb 7, 2026

Accepted on: Jul 19, 2026

Published on: Sep 7, 2026

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

DCIS,

upgrade,

Related subjects:

© 2026 Vladimir Urban, Zorica Milosevic, Zoran Bukumiric, Katarina Obradovic, Nina Adzic, Dragana Pavlovic-Stankovic, Ivana Petkovic, Ivana Sovic, Irena Jovanic, Igor Spurnic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 60 (2026): Issue 3 (September 2026)