Science to Practice: Why Do Purely Intraductal Cancers Enhance on Breast MR Images?

Because of the data presented by Jansen and coworkers (1), we now know that what we observe in patients with ductal carcinoma in situ (DCIS) is indeed the intraductal cancer directly. All empirical observations regarding DCIS enhancement on magnetic resonance (MR) images are now corroborated, and also explained, by the direct proof of gadolinium accumulation within the intraductal space. On the basis of this evidence, we may now further improve MR imaging strategies to aid us in the diagnosis of DCIS. These efforts are worthwhile: With the systematic use of MR imaging for screening, we may improve the detection rate of prognostically relevant DCIS not associated with calcifications. We may avoid the underdiagnosis of DCIS that is obviously occurring with mammographic screening alone. On the other hand, MR imaging may be used to guide treatment of DCIS because it may be useful in predicting the natural behavior of intraductal cancers.