TY - JOUR
T1 - Clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with ductal carcinoma in situ (DCIS)
T2 - a multi-institutional retrospective cohort study
AU - Tanaka, Kiyo
AU - Masuda, Norikazu
AU - Hayashi, Naoki
AU - Sagara, Yasuaki
AU - Hara, Fumikata
AU - Kadoya, Takayuki
AU - Matsui, Akira
AU - Miyazaki, Chieko
AU - Shien, Tadahiko
AU - Tokunaga, Eriko
AU - Hayashi, Takako
AU - Niikura, Naoki
AU - Maeda, Shigeto
AU - Komoike, Yoshihumi
AU - Bando, Hiroko
AU - Kanbayashi, Chizuko
AU - Iwata, Hiroji
N1 - Funding Information:
Dr. Norikazu Masuda reports grants, personal fees and other from Chugai and Eisai, personal fees and other from AstraZeneca, Pfizer, Elli-Lilly, Takeda, Kyowa-Kirin, Novartis, and Daiichi-Sankyo, other from MSD. Dr. Naoki Hayashi reports personal fees from Chugai, Novartis, AstraZeneca Kyowa-Kirin, Genomic Health inc, Allergan, Devixcor Japan, and Pfizer. Dr. Naoki Niikura reports grants and personal fees from Chugai, personal fees from AstraZeneca, Pfizer, Novartis and Eisai, grants from Nippon Mediphysics, Daiichi-Sankyo, BMS, and MSD. Dr. Hiroko Bando reports personal fees from AstraZeneca, Eisai, Kyowa-Kirin, Taiho, Chugai, Nihon Kayaku, Pfizer, and Novartis. Dr. Hiroji Iwata reports grants and personal fees from Novartis, AstraZeneca, Pfizer, Elli-Lilly, Daiichi-Sankyo, Kyowa-Kirin, and Chugai, grants from MSD and Byer, personal fees from Eisai. The others have nothing to disclose.
Funding Information:
We would like to thank the following institutions’ doctors and patients for providing us with data: Faculty of Medicine, University of Tsukuba, Jichi Medical University Hospital, National Hospital Organization Tokyo Medical Center, St. Luke’s International Hospital, Tokai University Hospital, Niigata Cancer Center Hospital, Aichi Cancer Center Hospital, National Hospital Organization Nagoya Medical Center, Kindai University Hospital, Okayama University Hospital, Hiroshima University Hospital, Shikoku Cancer Center, National Hospital Organization Kyusyu Cancer Center, National Hospital Organization Nagasaki Medical Center, Sagara Hospital. This report was supported in part by the National Cancer Center Research and Development Fund (26-A-4) from the Ministry of Health, Labour and Welfare and the Practical Research for Innovative Cancer Control (20ck0106429h0003) from the Japan Agency for Medical Research and Development, AMED.
Funding Information:
We would like to thank the following institutions? doctors and patients for providing us with data: Faculty of Medicine, University of Tsukuba, Jichi Medical University Hospital, National Hospital Organization Tokyo Medical Center, St. Luke?s International Hospital, Tokai University Hospital, Niigata Cancer Center Hospital, Aichi Cancer Center Hospital, National Hospital Organization Nagoya Medical Center, Kindai University Hospital, Okayama University Hospital, Hiroshima University Hospital, Shikoku Cancer Center, National Hospital Organization Kyusyu Cancer Center, National Hospital Organization Nagasaki Medical Center, Sagara Hospital. This report was supported in part by the National Cancer Center Research and Development Fund (26-A-4) from the Ministry of Health, Labour and Welfare and the Practical Research for Innovative Cancer Control (20ck0106429h0003) from the Japan Agency for Medical Research and Development, AMED.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/7
Y1 - 2021/7
N2 - Background: We 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 methods: We 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. Results: We 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. 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.
AB - Background: We 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 methods: We 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. Results: We 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. 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.
KW - Breast cancer
KW - Ductal carcinoma in situ
KW - Dynamic magnetic resonance imaging
KW - Predictive factors
KW - Upstaging
UR - http://www.scopus.com/inward/record.url?scp=85101263239&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101263239&partnerID=8YFLogxK
U2 - 10.1007/s12282-021-01225-0
DO - 10.1007/s12282-021-01225-0
M3 - Article
C2 - 33599914
AN - SCOPUS:85101263239
VL - 28
SP - 896
EP - 903
JO - Breast Cancer
JF - Breast Cancer
SN - 1340-6868
IS - 4
ER -