J Surg Ultrasound.  2019 Nov;6(2):38-45. 10.0000/jsu.2019.6.2.38.

Clinical Predictors of Upstaging to Invasive Cancer Postoperatively in Patients Diagnosed with Ductal Carcinoma In Situ before Surgery

• Lee KH
• Han JW
• Kim EY
• Yun JS
• Park YL
• Park CH

• KMID: 2469747
• DOI: http://doi.org/10.0000/jsu.2019.6.2.38

Abstract

PURPOSE
Upstaging to invasive cancer (IC) is often found after surgery in those patients diagnosed with ductal carcinoma in situ (DCIS) and who underwent preoperative needle biopsy. This may change the post-surgical plans that include the re-operation, chemotherapy, and/or radiotherapy. Yet, there are no clinically available factors to predict IC in preoperatively diagnosed DCIS patients. This study evaluated the clinical and pathological predictive risk factors for upgrading DCIS to IC.
METHODS
This study retrospectively evaluated those patients who were diagnosed with DCIS preoperatively, and this diagnosis was followed by performing breast surgery between Jan 2005 and June 2018. Clinico-pathological factors were collected for the analysis between the pure DCIS group and the IC group.
RESULTS
Of the 431 patients included in the study, 34 (7.9%) were upstaged to IC after surgery, and 397 (92.1%) were diagnosed as having pure DCIS. The nuclear grade was the sole predictor of upstaging to IC on the analysis of the clinico-pathological factors (odds ratio [OR] = 2.39, 95% confidence interval [95% CI] = 1.05-5.42, P = 0.038 on the univariate analysis; aOR = 2.86, 95% CI = 1.14-7.14, P = 0.025 on the multivariate analysis). The mass's size and characteristics, as determined by sonography, were not predictive of IC.
CONCLUSION
The sonographic findings were not significant factors for predicting IC in preoperative DCIS patients. A high nuclear grade was the only statistically significant factor associated with IC. Considering the variability of the gauge of biopsy needles or the method for needle biopsy, large-scale prospective studies that control these variables may well reveal available predictive factors of IC in patients with DCIS.

Keyword

Carcinoma; Intraductal; Noninfiltrating; Breast; Carcinoma; Ductal; Risk factor

MeSH Terms

Biopsy
Biopsy, Needle
Breast
Carcinoma, Ductal*
Carcinoma, Intraductal, Noninfiltrating*
Diagnosis
Drug Therapy
Humans
Methods
Needles
Prospective Studies
Radiotherapy
Retrospective Studies
Risk Factors
Ultrasonography

Figure

• 

  Fig. 1 Non-mass vs. mass lesion on pre-operative breast sonography. (A) Non mass lesion on pre-operative breast US, left breast 10H, BI-RADS C4a, diagnosed of DCIS on CNB, (B) Mass lesion on pre-operative breast US, left breast 12H, subareolar area, BI-RADS C4a, diagnosed of DCIS on CNB. BI-RADS = breast imaging-reporting and data system; CNB = core needle biopsy; DCIS = ductal carcinoma in situ; US = ultrasonography.

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