Abstract
We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. A total of 3100 VABBs were retrospectively reviewed, among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients' features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate and multivariate analysis. Finally, we developed a nomogram for predicting the upstage at surgery, according to the multivariate logistic regression model. The overall upgrade rate to invasive carcinoma was 10.8%. At univariate analysis, the risk of upgrade was significantly lower in patients with greater age (p = 0.018), without post-biopsy residual lesion (p < 0.001), with a smaller post-biopsy residual lesion size (p < 0.001), and in the presence of low-grade DCIS only in specimens with microcalcifications (p = 0.002). According to the final multivariable model, the predicted probability of upstage at surgery was lower than 2% in 58 patients; among these 58 patients, only one (1.7%) upstage was observed, showing a good calibration of the model. An easy-to-use nomogram for predicting the upstage at surgery based on radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.
Highlights
Breast cancer is one of the most prevalent malignancies among women worldwide, still leading to a considerable incidence of death; in 2020, almost 685,000 women were deceased owing to this malignancy [1]
The purpose of our study is to identify a predictive model that identifies the features, mainly based on imaging, that can predict the diagnostic underestimation of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma or worst grade DCIS
We investigated a potential correlation between patient’s age, lesion size, diameter of the needle, number of cores, complete macroscopic removal of the lesion, cases showing low-grade DCIS only in cores with microcalcifications, and the chance of upgrade to a worst grade DCIS or invasive ductal carcinoma (IDC)
Summary
Breast cancer is one of the most prevalent malignancies among women worldwide, still leading to a considerable incidence of death; in 2020, almost 685,000 women were deceased owing to this malignancy [1]. A meta-analysis of underestimation and predictors of invasive breast cancer showed that up to 26% of patients with biopsy-proven DCIS can reveal a synchronous invasive carcinoma in surgical specimens [8]. As this percentage is unacceptable, it is necessary to reduce the diagnostic underestimation of the VABB before proposing active surveillance to patients. Four prospective international study protocols (LORIS, COMET, LORD, and LORETTA) are currently in place to evaluate non-invasive treatment strategies for DCIS; a selection of patient population based on clinical and radiological features (which may reduce the diagnostic underestimation of the biopsy) appears to be neglected in these protocols [10].
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