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Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast.
Br J Surg. 2013 Dec; 100(13):1756-63.BJ

Abstract

BACKGROUND

The aim of this study was to identify risk factors for invasive breast cancer in patients diagnosed with ductal carcinoma in situ (DCIS) on a preoperative biopsy. These factors were used to develop a nomogram for predicting the risk of invasion in the preoperative setting.

METHODS

This was a retrospective analysis of patients who underwent surgical treatment for DCIS diagnosed before surgery between 1997 and 2009. Multivariable analysis was used to identify clinical, radiological and histopathological factors that may predict upstaging. A nomogram was developed to predict the probability of invasion using multiple logistic regression analysis. This nomogram was subsequently validated using another cohort of patients with a preoperative diagnosis of DCIS between 2010 and 2012.

RESULTS

Upstaging to invasive cancer occurred in 123 (24.9 per cent) of 493 women treated between 1997 and 2009. A larger DCIS lesion (at least 15 mm), lack of hormone receptor expression, intermediate or high nuclear grade, diagnosis on core biopsy compared with vacuum-assisted biopsy, and non-cribriform subtype of DCIS were significantly associated with upstaging. A nomogram developed using these factors demonstrated good predictive performance (area under the receiver operating characteristic (ROC) curve (AUC) 0·823, 95 per cent confidence interval 0·787 to 0·860). The nomogram showed similar predictive performance in the validation data set, based on another 149 women (AUC 0·700, 0·613 to 0·786).

CONCLUSION

Upstaging to invasive cancer in women with a preoperative diagnosis of DCIS is common. A nomogram based on the five most significant factors related to upstaging accurately predicted invasive cancer. This nomogram may be useful when deciding whether to pursue axillary staging with sentinel lymph node biopsy in patients with DCIS.

Authors+Show Affiliations

Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24227361

Citation

Lee, S K., et al. "Nomogram for Predicting Invasion in Patients With a Preoperative Diagnosis of Ductal Carcinoma in Situ of the Breast." The British Journal of Surgery, vol. 100, no. 13, 2013, pp. 1756-63.
Lee SK, Yang JH, Woo SY, et al. Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg. 2013;100(13):1756-63.
Lee, S. K., Yang, J. H., Woo, S. Y., Lee, J. E., & Nam, S. J. (2013). Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. The British Journal of Surgery, 100(13), 1756-63. https://doi.org/10.1002/bjs.9337
Lee SK, et al. Nomogram for Predicting Invasion in Patients With a Preoperative Diagnosis of Ductal Carcinoma in Situ of the Breast. Br J Surg. 2013;100(13):1756-63. PubMed PMID: 24227361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. AU - Lee,S K, AU - Yang,J-H, AU - Woo,S-Y, AU - Lee,J E, AU - Nam,S J, PY - 2013/09/16/accepted PY - 2013/11/15/entrez PY - 2013/11/15/pubmed PY - 2014/1/8/medline SP - 1756 EP - 63 JF - The British journal of surgery JO - Br J Surg VL - 100 IS - 13 N2 - BACKGROUND: The aim of this study was to identify risk factors for invasive breast cancer in patients diagnosed with ductal carcinoma in situ (DCIS) on a preoperative biopsy. These factors were used to develop a nomogram for predicting the risk of invasion in the preoperative setting. METHODS: This was a retrospective analysis of patients who underwent surgical treatment for DCIS diagnosed before surgery between 1997 and 2009. Multivariable analysis was used to identify clinical, radiological and histopathological factors that may predict upstaging. A nomogram was developed to predict the probability of invasion using multiple logistic regression analysis. This nomogram was subsequently validated using another cohort of patients with a preoperative diagnosis of DCIS between 2010 and 2012. RESULTS: Upstaging to invasive cancer occurred in 123 (24.9 per cent) of 493 women treated between 1997 and 2009. A larger DCIS lesion (at least 15 mm), lack of hormone receptor expression, intermediate or high nuclear grade, diagnosis on core biopsy compared with vacuum-assisted biopsy, and non-cribriform subtype of DCIS were significantly associated with upstaging. A nomogram developed using these factors demonstrated good predictive performance (area under the receiver operating characteristic (ROC) curve (AUC) 0·823, 95 per cent confidence interval 0·787 to 0·860). The nomogram showed similar predictive performance in the validation data set, based on another 149 women (AUC 0·700, 0·613 to 0·786). CONCLUSION: Upstaging to invasive cancer in women with a preoperative diagnosis of DCIS is common. A nomogram based on the five most significant factors related to upstaging accurately predicted invasive cancer. This nomogram may be useful when deciding whether to pursue axillary staging with sentinel lymph node biopsy in patients with DCIS. SN - 1365-2168 UR - https://www.unboundmedicine.com/medline/citation/24227361/Nomogram_for_predicting_invasion_in_patients_with_a_preoperative_diagnosis_of_ductal_carcinoma_in_situ_of_the_breast_ DB - PRIME DP - Unbound Medicine ER -