ARRS 2022 Abstracts

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E1692. Beyond Calcifications: Unusual Presentations of DCIS
Authors
  1. Christine Guerrini; Maine Medical Center; Tufts University School of Medicine
  2. Christina Cinelli; Maine Medical Center; Tufts University School of Medicine
  3. Elizabeth Pietras; Maine Medical Center; Tufts University School of Medicine
Background
Ductal carcinoma in situ (DCIS) is a commonly encountered entity in breast imaging. It is a non-obligate precursor to invasive cancer and lies on the spectrum between normal ducts and invasive ductal carcinoma. DCIS is most often associated with its classical imaging characteristic, that of high-risk patterns of microcalcifications found on screening mammography. In practice, however, the presentation and imaging findings of ductal carcinoma in situ can vary significantly. This educational presentation looks at the pathophysiology and clinical significance of DCIS. We then discuss the less common presentations and imaging appearances of DCIS through multiple example cases.

Educational Goals / Teaching Points
The goals of this exhibit are to review the pathophysiology and common imaging findings of DCIS; become familiar with less common clinical presentations and imaging appearances that DCIS may exhibit; and discuss the importance of reviewing the radiologic/pathologic concordance at both biopsy and surgery, particularly when there is DCIS.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Although DCIS is commonly associated with asymptomatic mammographically apparent microcalcifications, it can have a varied appearance on mammogram, ultrasound, and MRI, mimicking other breast lesions such as fibroadenomas and invasive cancers. Our case selection and discussion aims to showcase several different appearances of pathology-proven DCIS, highlighting the less common presentations.

Conclusion
Although the term DCIS often conjures a specific mammographic image in the minds of those who read breast imaging, its presentation and imaging appearance can take many forms, sometimes mimicking other benign and malignant breast entities. As the treatment algorithms for DCIS and invasive cancer differ greatly, it is important for radiologists who read breast imaging to understand the pathophysiology of ductal disease and be aware of the various forms DCIS can take.