A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast

Takafumi Kondo, Naoki Hayashi, Sachiko Ohde, Koyu Suzuki, Atsushi Yoshida, Hiroshi Yagata, Naoki Niikura, Takayuki Iwamoto, Kumiko Kida, Michiko Murai, Yuko Takahashi, Hiroko Tsunoda, Seigo Nakamura, Hideko Yamauchi

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15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)476-480
Number of pages5
JournalJournal of Surgical Oncology
Volume112
Issue number5
DOIs
Publication statusPublished - Oct 2015

Keywords

  • breast cancer
  • ductal carcinoma in situ
  • nomogram
  • sclerosing adenosis

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Kondo, T., Hayashi, N., Ohde, S., Suzuki, K., Yoshida, A., Yagata, H., Niikura, N., Iwamoto, T., Kida, K., Murai, M., Takahashi, Y., Tsunoda, H., Nakamura, S., & Yamauchi, H. (2015). A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast. Journal of Surgical Oncology, 112(5), 476-480. https://doi.org/10.1002/jso.24037