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Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ.
Breast J. 2007 May-Jun; 13(3):251-7.BJ

Abstract

Core needle biopsy (CNB) is used to sample both mammographically and ultrasound detected breast lesions. A diagnosis of ductal carcinoma in situ (DCIS) by CNB does not ensure the absence of invasive cancer upon surgical excision and as a result an upstaged patient may need to undergo additional surgery for axillary nodal evaluation. This study evaluates the accuracy of CNB in excluding invasive disease and the preoperative features that predict upstaging of DCIS to invasive breast cancer. Two hundred fifty-four patients over an 8-year period from 1994 to 2002 with a diagnosis of DCIS alone by CNB were retrospectively reviewed. Underestimation of invasive cancer by CNB was determined. Radiographic, pathologic, and surgical features of the cohort were compared using univariate and multivariate analysis. The mean age was 55 years (range 27-84) and mean follow-up was 25 months with one patient unavailable for follow-up. There were a total of six patient deaths, all of which were not disease-specific. A total of 21 out of 254 patients (8%) with DCIS by CNB were upstaged to invasive cancer following surgical excision. There was a significant inverse relationship between the number of core biopsies and the incidence of upstaging (p < 0.006) in that patients with fewer core samples were more likely to be upstaged at surgical pathology. No relationship was noted between the size of the core samples and the likelihood of upstaging (p > 0.4). Of 21 patients with invasion, all but two had comedonecrosis by CNB. Comedonecrosis by CNB significantly increased the likelihood of upstaging (p < 0.001). Of the 21 patients who were upstaged, 12 required subsequent surgery for nodal evaluation while nine had sentinel node biopsy at initial operation. Finally, upstaged patients were significantly more likely to have a positive margin (p < 0.008). Ductal carcinoma in situ with comedonecrosis on CNB can help to predict the possibility of invasion. Increasing the number of core biopsies reduced the likelihood of sampling error.

Authors+Show Affiliations

Maine Medical Center, Portland, Maine 04102, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17461899

Citation

Rutstein, Lisa A., et al. "Predictors of Residual Invasive Disease After Core Needle Biopsy Diagnosis of Ductal Carcinoma in Situ." The Breast Journal, vol. 13, no. 3, 2007, pp. 251-7.
Rutstein LA, Johnson RR, Poller WR, et al. Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ. Breast J. 2007;13(3):251-7.
Rutstein, L. A., Johnson, R. R., Poller, W. R., Dabbs, D., Groblewski, J., Rakitt, T., Tsung, A., Kirchner, T., Sumkin, J., Keenan, D., Soran, A., Ahrendt, G., & Falk, J. S. (2007). Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ. The Breast Journal, 13(3), 251-7.
Rutstein LA, et al. Predictors of Residual Invasive Disease After Core Needle Biopsy Diagnosis of Ductal Carcinoma in Situ. Breast J. 2007 May-Jun;13(3):251-7. PubMed PMID: 17461899.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of residual invasive disease after core needle biopsy diagnosis of ductal carcinoma in situ. AU - Rutstein,Lisa A, AU - Johnson,Ronald R, AU - Poller,William R, AU - Dabbs,David, AU - Groblewski,Jan, AU - Rakitt,Tina, AU - Tsung,Allan, AU - Kirchner,Thomas, AU - Sumkin,Jules, AU - Keenan,Donald, AU - Soran,Atilla, AU - Ahrendt,Gretchen, AU - Falk,Jeffrey S, PY - 2007/4/28/pubmed PY - 2007/7/20/medline PY - 2007/4/28/entrez SP - 251 EP - 7 JF - The breast journal JO - Breast J VL - 13 IS - 3 N2 - Core needle biopsy (CNB) is used to sample both mammographically and ultrasound detected breast lesions. A diagnosis of ductal carcinoma in situ (DCIS) by CNB does not ensure the absence of invasive cancer upon surgical excision and as a result an upstaged patient may need to undergo additional surgery for axillary nodal evaluation. This study evaluates the accuracy of CNB in excluding invasive disease and the preoperative features that predict upstaging of DCIS to invasive breast cancer. Two hundred fifty-four patients over an 8-year period from 1994 to 2002 with a diagnosis of DCIS alone by CNB were retrospectively reviewed. Underestimation of invasive cancer by CNB was determined. Radiographic, pathologic, and surgical features of the cohort were compared using univariate and multivariate analysis. The mean age was 55 years (range 27-84) and mean follow-up was 25 months with one patient unavailable for follow-up. There were a total of six patient deaths, all of which were not disease-specific. A total of 21 out of 254 patients (8%) with DCIS by CNB were upstaged to invasive cancer following surgical excision. There was a significant inverse relationship between the number of core biopsies and the incidence of upstaging (p < 0.006) in that patients with fewer core samples were more likely to be upstaged at surgical pathology. No relationship was noted between the size of the core samples and the likelihood of upstaging (p > 0.4). Of 21 patients with invasion, all but two had comedonecrosis by CNB. Comedonecrosis by CNB significantly increased the likelihood of upstaging (p < 0.001). Of the 21 patients who were upstaged, 12 required subsequent surgery for nodal evaluation while nine had sentinel node biopsy at initial operation. Finally, upstaged patients were significantly more likely to have a positive margin (p < 0.008). Ductal carcinoma in situ with comedonecrosis on CNB can help to predict the possibility of invasion. Increasing the number of core biopsies reduced the likelihood of sampling error. SN - 1075-122X UR - https://www.unboundmedicine.com/medline/citation/17461899/Predictors_of_residual_invasive_disease_after_core_needle_biopsy_diagnosis_of_ductal_carcinoma_in_situ_ L2 - https://doi.org/10.1111/j.1524-4741.2007.00418.x DB - PRIME DP - Unbound Medicine ER -