Takafumi Kondo1, Naoki Hayashi1, Sachiko Ohde2, Koyu Suzuki3, Atsushi Yoshida1, Hiroshi Yagata1, Naoki Niikura4, Takayuki Iwamoto5, Kumiko Kida1, Michiko Murai1, Yuko Takahashi1, Hiroko Tsunoda6, Seigo Nakamura7, Hideko Yamauchi1. 1. Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan. 2. St. Luke's Life Science Institute Center for Clinical Epidemiology, Tokyo, Japan. 3. Departments of Pathology, St. Luke's International Hospital, Tokyo, Japan. 4. Departments of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan. 5. Department of Gastroenterological Surgery and Surgical Oncology, Okayama University, Okayama, Japan. 6. Departments of Radiology, St. Luke's International Hospital, Tokyo, Japan. 7. Department of Surgery, Division of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: The aims of this study were to determine clinicopathological factors associated with postoperative upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ (DCIS) and to develop a model to predict the risk of upstaging. METHODS: Pre- and post-operative pathological diagnoses and radiological findings were assessed for 1,187 consecutive patients. RESULTS: Of the patients, 306 (25.8%) were upstaged on the surgical specimen. In multivariate analysis, the following four factors were significantly associated with upstaging: 1) the presence of sclerosing adenosis on the preoperative biopsy specimen (odds ratio [OR] 0.46, P = 0.013); 2) pleomorphic calcifications on the mammogram (OR 1.68, P = 0.009); 3) a mass suspicious for invasive carcinoma on ultrasonography and/or MRI (OR 2.13, P < 0.001); 4) tumor size ≥2 cm on ultrasonography (OR 1.80, P = 0.032). HER2-positive (OR 1.54, P = 0.062) and comedo necrosis (OR 1.42, P = 0.056) demonstrated a trend towards significance. A prediction model incorporating these variables demonstrated that the risk of upstaging was 5.1% with score 0-2 and was 58.1% with score 10. CONCLUSIONS: The prediction model incorporating clinicopathological features may be used to guide the selection of patients with DCIS for sentinel lymph node biopsy.
BACKGROUND: The aims of this study were to determine clinicopathological factors associated with postoperative upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ (DCIS) and to develop a model to predict the risk of upstaging. METHODS: Pre- and post-operative pathological diagnoses and radiological findings were assessed for 1,187 consecutive patients. RESULTS: Of the patients, 306 (25.8%) were upstaged on the surgical specimen. In multivariate analysis, the following four factors were significantly associated with upstaging: 1) the presence of sclerosing adenosis on the preoperative biopsy specimen (odds ratio [OR] 0.46, P = 0.013); 2) pleomorphic calcifications on the mammogram (OR 1.68, P = 0.009); 3) a mass suspicious for invasive carcinoma on ultrasonography and/or MRI (OR 2.13, P < 0.001); 4) tumor size ≥2 cm on ultrasonography (OR 1.80, P = 0.032). HER2-positive (OR 1.54, P = 0.062) and comedo necrosis (OR 1.42, P = 0.056) demonstrated a trend towards significance. A prediction model incorporating these variables demonstrated that the risk of upstaging was 5.1% with score 0-2 and was 58.1% with score 10. CONCLUSIONS: The prediction model incorporating clinicopathological features may be used to guide the selection of patients with DCIS for sentinel lymph node biopsy.
Authors: Claudia J C Meurs; Joost van Rosmalen; Marian B E Menke-Pluijmers; Bert P M Ter Braak; Linda de Munck; Sabine Siesling; Pieter J Westenend Journal: Br J Cancer Date: 2018-10-17 Impact factor: 7.640
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Authors: Ko Woon Park; Seon Woo Kim; Heewon Han; Minsu Park; Boo-Kyung Han; Eun Young Ko; Ji Soo Choi; Eun Yoon Cho; Soo Youn Cho; Eun Sook Ko Journal: NPJ Breast Cancer Date: 2022-01-14