Yonsei Med J.  2019 Nov;60(11):1028-1035. 10.3349/ymj.2019.60.11.1028.

An Updated Nomogram for Predicting Invasiveness in Preoperative Ductal Carcinoma In Situ of the Breast

Affiliations
  • 1Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. imgenius@yuhs.ac
  • 3Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy.
MATERIALS AND METHODS
Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous version of the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups according to the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student's t-test, and binary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index and Hosmer"”Lemeshow goodness of fit test.
RESULTS
The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperative pathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% of patients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis were operation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographic mass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type, sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model with these variables showed moderate discrimination and was appropriate in the calibration test.
CONCLUSION
The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.

Keyword

Breast neoplasms; prediction; ductal carcinoma in situ; upstaging

MeSH Terms

Biopsy
Breast Neoplasms
Breast*
Calibration
Carcinoma, Ductal*
Carcinoma, Intraductal, Noninfiltrating*
Cohort Studies
Discrimination (Psychology)
Humans
Logistic Models
Medical Records
Methods
Multivariate Analysis
Necrosis
Nomograms*
Pathology
Receptor, Epidermal Growth Factor
Risk Factors
ROC Curve
Ultrasonography
Receptor, Epidermal Growth Factor

Figure

  • Fig. 1 Patient cohort. DCIS, ductal carcinoma in situ.

  • Fig. 2 An updated nomogram. BCS, breast-conserving surgery; HER2/neu, human epidermal growth factor receptor 2; MMG, mammographic.

  • Fig. 3 Receiver operating characteristic curve for external validation with the independent data set (n=115). AUC, area under the curve.


Cited by  1 articles

수술전 관상피내암 환자의 수술후 침윤암 진단 예측인자
Kwan Ho Lee, Jeong Woo Han,, Eun Young Kim, Ji Sup Yun, Yong Lai Park, Chan Heun Park
J Surg Ultrasound. 2019;6(2):38-45.    doi: 10.46268/jsu.2019.6.2.38.


Reference

1. Giordano SH, Elias AD, Gradishar WJ. NCCN guidelines updates: breast cancer. J Natl Compr Canc Netw. 2018; 16(5S):605–610. PMID: 29784737.
Article
2. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003; 349:546–553. PMID: 12904519.
Article
3. Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2017; 35:561–564. PMID: 27937089.
Article
4. Prendeville S, Ryan C, Feeley L, O'Connell F, Browne TJ, O'Sullivan MJ, et al. Sentinel lymph node biopsy is not warranted following a core needle biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast. Breast. 2015; 24:197–200. PMID: 25681861.
Article
5. Sakr R, Bezu C, Raoust I, Antoine M, Ettore F, Darcourt J, et al. The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes. Int J Clin Pract. 2008; 62:1730–1735. PMID: 19143859.
Article
6. Tan EY, Lo ZW, Ang CH, Teo C, Seah MD, Chen JJ, et al. Sentinel lymph node biopsy should be included with the initial surgery for high-risk ductal carcinoma-in-situ. Int Sch Res Notices. 2014; 2014:624185. PMID: 27379334.
Article
7. Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011; 260:119–128. PMID: 21493791.
Article
8. Sakr R, Antoine M, Barranger E, Dubernard G, Salem C, Daraï E, et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma. Breast J. 2008; 14:55–60. PMID: 18186866.
Article
9. Coufal O, Selingerová I, Vrtělová P, Krsička P, Gabrielová L, Fabian P, et al. A simple model to assess the probability of invasion in ductal carcinoma in situ of the breast diagnosed by needle biopsy. Biomed Res Int. 2014; 2014:480840. PMID: 25114904.
Article
10. Park HS, Kim HY, Park S, Kim EK, Kim SI, Park BW. A nomogram for predicting underestimation of invasiveness in ductal carcinoma in situ diagnosed by preoperative needle biopsy. Breast. 2013; 22:869–873. PMID: 23601760.
Article
11. Lee SK, Yang JH, Woo SY, Lee JE, Nam SJ. Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg. 2013; 100:1756–1763. PMID: 24227361.
Article
12. Kondo T, Hayashi N, Ohde S, Yagata H, Yoshida A, Nakamura S, et al. A nomogram associated with high probability of invasive carcinoma on the surgical specimen in patients with preoperative diagnosis of ductal carcinoma in situ of the breast. J Clin Oncol. 2014; 32(15_Suppl):1595. PMID: 24752047.
Article
13. Jakub JW, Murphy BL, Gonzalez AB, Conners AL, Henrichsen TL, Maimone S 4th, et al. A validated nomogram to predict upstaging of ductal carcinoma in situ to invasive disease. Ann Surg Oncol. 2017; 24:2915–2924. PMID: 28766196.
Article
14. Meurs CJC, van Rosmalen J, Menke-Pluijmers MBE, Ter Braak BPM, de Munck L, Siesling S, et al. A prediction model for underestimation of invasive breast cancer after a biopsy diagnosis of ductal carcinoma in situ: based on 2892 biopsies and 589 invasive cancers. Br J Cancer. 2018; 119:1155–1162. PMID: 30327564.
Article
15. Park HS, Park S, Cho J, Park JM, Kim SI, Park BW. Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy. J Surg Oncol. 2013; 107:388–392. PMID: 23007901.
Article
16. Kang SY, Kim YS, Kim Z, Kim HY, Lee SK, Jung KW, et al. Basic findings regarding breast cancer in Korea in 2015: data from a breast cancer registry. J Breast Cancer. 2018; 21:1–10. PMID: 29628978.
Article
17. Duffy SW, Dibden A, Michalopoulos D, Offman J, Parmar D, Jenkins J, et al. Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol. 2016; 17:109–114. PMID: 26655422.
Article
18. Suh YJ, Kim MJ, Kim EK, Moon HJ, Kwak JY, Koo HR, et al. Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy. Br J Radiol. 2012; 85:e349–e356. PMID: 22422382.
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr