Detecting When DCIS will Progress to IDC
Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer that can potentially progress to invasive cancer if left untreated. Early detection and treatment are therefore crucial.
In a retrospective study of patients with DCIS who declined surgery and received endocrine therapy, published in njp: Breast Cancer, researchers highlighted the importance of MRI in assessing DCIS risk and guiding treatment decisions in women who elect not to undergo standard surgical management and instead opt for endocrine treatment and imaging surveillance. The retrospective study identified MRI features in patients on endocrine therapy undergoing active surveillance that may predict a high risk for subsequent invasive cancer versus low risk for invasive cancer.
The study by lead author Heather Greenwood, MD, along with Rita Freimanis, MD, and Nola Hylton, PhD, and colleagues from the UCSF departments of surgery, medicine, and pathology, found that when patients were actively monitored while undergoing endocrine therapy radiologists can help identify the lesions at higher risk of progressing to invasive cancer for whom surgery may be the best treatment and those with lesions at lower risk who may safely stay on active surveillance with MRI follow-up.
The data analysis identified specific danger indicators and demonstrated how MRI can be used to track changes in DCIS lesions and assess the effectiveness of treatment. This allows providers to tailor treatment plans for individual patients with DCIS. The presence of a distinct lesion, especially if it persists or becomes more focal, as well as changes in background parenchymal enhancement (BPE), are risk factors for invasive cancer. Patients with low-risk DCIS may benefit from endocrine risk reduction rather than surgery, and the data showed that endocrine therapy often caused these low-risk lesions to shrink or disappear.
While screening mammography is effective in detecting DCIS and targeting lesions for removal, this standard practice hasn't led to a decrease in invasive cancer incidence. This suggests that the majority of DCIS lesions are low-risk and amenable to non-surgical treatment strategies. Greenwood and her team demonstrated that MRI features after short-term endocrine therapy can help identify DCIS lesions with high, low, or intermediate risk of progressing to invasive disease.
The study found that active monitoring of patients undergoing endocrine therapy allows radiologists to identify high-risk lesions. This approach is safe and provides valuable information for patients and clinicians, as many at-risk patients already receive six months of neoadjuvant endocrine therapy.
Greenwood and her team hope that the use of MRI imaging will contribute to better personalized therapy and reduce the risk of surgical overtreatment for women with ductal carcinoma in situ.
