Assignment on Imaging of Ductal Carcinoma In situ

Running head: IMAGING OF DUCTAL CARCINOMA IN SITU
Imaging of Ductal Carcinoma In situ
Name of the Student
Name of the University
Author Note

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Introduction
Ductal carcinoma in situ (DCIS) is a kind of malignant tumour with a non-invasive
property and limited to milk ducts. A patient named Shailey who is 59-years old visited a
breast screening clinic after noticing an area of redness in her left breast. She has no family
history of breast cancer. Breast imaging is required for the initial diagnosis of the disease
being suspected. Primary imaging was performed on Shailey using mammography to
visualise and differentiate between linear and granular calcification. Due to a limitation of the
mammogram, that it does not detect non-calcified DCIS, the doctor called her for further
assessment for confirmed diagnosis as he suspects Ductal carcinoma in situ. The doctor used
an accurate imaging technique that is Magnetic Resonance Imaging (MRI) to analyse both
types of DCIS (Pickles et al. 2015). Ductal carcinoma is characterised by a lump and
swelling in the breast, redness, and pain, which is similar to symptoms presented by Shailey.
After differentiating the normal and abnormal appearances of the imaging reports, the doctor
selected an appropriate treatment with a specific dose for her by age. The most effective
treatment with fewer chances of recurrence is adjuvant radiation therapy. Shailey was sent to
a trained radiologist who performed radiation therapy. She was given standardized high
dosage radiation partially to the left breast which shows a lesion for a shorter period of time.
This essay will discuss the imaging and management procedure followed by the consultant to
recommend possible treatment and follow up of a 59-year old patient Shailey.
Discussion
Diagnosis through imaging techniques
Initially, mammography was used to diagnose breast cancer to reduce the risk of
breast cancer. In a study, it was shown than mammography reduced breast cancer by up to
25% (Løberg et al. 2015). The following steps were followed for performing mammography

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of the left breast of Shailey- firstly she had to remove all the pieces of jewellery and clothes
from her upper body, she is instructed to stand in front of the mammogram that is a special
form of X-ray machine, then the technician placed her left breast on a platform and adjusted
the height of the platform to avoid unhindered view of the breast, then her breast is slowly
pressed by a transparent plastic plate to spread out the tissue of the breast, and finally X-ray
was passed through the uniformly spread breast while she was asked to hold her breath and
stand straight (Mayoclinic.org 2020).
In the opinion of Løberg et al. (2015) overdiagnosis can cause harm to incase of
ductal carcinoma in situ and invasive carcinoma. Screening can detect breast cancer at an
early stage when the tumours are not invasive but if there are wrong assumptions of the
tumour growth, then a mammogram can be an inadequate tool for screening. The screening
method should be eligible for use between the age of 40 to 74 years (Løberg et al. 2015).
All diagnostic test differs in their specificity and sensitivity; therefore, mammogram
screening can give false-positive results. Studies based on statistics of the UK women showed
that 2.3% of the total women population undergo false-positive results, and in Europe, around
20% of the women have experienced false-positive tests (Løberg et al. 2015). However,
mammogram has low sensitivity and specificity for which new modalities such as breast MRI
is in increasing demand for detection of breast cancer. The appearance of microcalcifications
under mammography as mass is known as low-grade DCIS and as fine linear branching is
known as high-grade DCIS. (Radiologyassistant.nl 2020) as shown in figure 1a) and 1b).

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Figure 1: a) and b) Punctate and amorphous calcifications (low-grade DCIS)
(Image retrieved from Radiologyassistant.nl 2020)
Presence of artefacts can raise a difficulty. Contrast-enhanced digital mammography
(CEDM) uses intravenous iodine contrast and can sometimes show artefacts of skin
contamination mimicking in situ carcinoma. CEDM is conducted by injecting iodinated
contrast intravenously into the patient and then performing mammography with low energy
and high energy x-ray spectra. Both of the energies are applied, and in the post-processing,
background tissue is suppressed by high and low energy image pair and iodinated contrast is
highlighted showing a combined image. Patients suspected with calcified DCIS and non-
mass enhanced DCIS on the left breast show no abnormality under MRI and biopsy revealed
benign pathology as demonstrated by figures 2a) and 2b). Such findings prove that artefacts
mimicking calcifications and non-mass enhancements of in situ carcinoma appear due to skin
contaminated with iodine (Gluskin et al. 2017).