Abstract
BackgroundWe conducted a prospective study with the intention to omit surgery for patients with ductal carcinoma in situ (DCIS) of the breast. We aimed to identify clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with DCIS.Patients and methodsWe retrospectively analyzed patients with DCIS diagnosed through biopsy between April 1, 2010 and December 31, 2014, from 16 institutions. Clinical, radiological, and histological variables were collected from medical records.ResultsWe identified 2,293 patients diagnosed with DCIS through biopsy, including 1,663 DCIS (72.5%) cases and 630 IDC (27.5%) cases. In multivariate analysis, the presence of a palpable mass (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.2–2.6), mammography findings (≥ category 4; OR 1.8; 95% CI 1.2–2.6), mass formations on ultrasonography (OR 1.8; 95% CI 1.2–2.5), and tumor size on MRI (> 20 mm; OR 1.7; 95% CI 1.2–2.4) were independent predictors of IDC. Among patients with a tumor size on MRI of ≤ 20 mm, the possibility of postoperative upstaging to IDC was 22.1%. Among the 258 patients with non-palpable mass, nuclear grade 1/2, and positive for estrogen receptor, the possibility was 18.1%, even if the upper limit of the tumor size on MRI was raised to ≤ 40 mm.ConclusionWe identified four independent predictive factors of upstaging to IDC after surgery among patients with DCIS diagnosed by biopsy. The combined use of various predictors of IDC reduces the possibility of postoperative upstaging to IDC, even if the tumor size on MRI is larger than 20 mm.
Highlights
The increase in breast cancer screening programs has contributed to a dramatic increase in the incidence of ductal carcinoma in situ (DCIS), and more than 20% of breast cancers diagnosed by screening mammography (MMG) are DCIS according to a recent study [1]
We considered the relationship between tumor size, including non-mass enhancement on magnetic resonance imaging (MRI), plus preoperative clinicopathological factors and the possibility of postoperative upstaging to invasive ductal carcinoma (IDC) on postoperative specimens
We identified the following four independent clinicopathological predictive factors of postoperative upstaging to IDC among patients with DCIS diagnosed by biopsy in this retrospective study: presence of a palpable mass, MMG findings (≥ category 4), mass formations on US, and tumor size on MRI (> 20 mm)
Summary
The increase in breast cancer screening programs has contributed to a dramatic increase in the incidence of ductal carcinoma in situ (DCIS), and more than 20% of breast cancers diagnosed by screening mammography (MMG) are DCIS according to a recent study [1]. The Japan Breast Cancers Guideline recommends that sentinel lymph node biopsy (SLNB) can be omitted in DCIS patients treated with breast-conserving surgery and predicted to have no invasion [2]; in daily practice, SLNB is sometimes omitted. We aimed to identify clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with DCIS. Among patients with a tumor size on MRI of ≤ 20 mm, the possibility of postoperative upstaging to IDC was 22.1%. Conclusion We identified four independent predictive factors of upstaging to IDC after surgery among patients with DCIS diagnosed by biopsy. The combined use of various predictors of IDC reduces the possibility of postoperative upstaging to IDC, even if the tumor size on MRI is larger than 20 mm
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