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A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast.
J Surg Oncol. 2015 Oct; 112(5):476-80.JS

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.

Authors+Show Affiliations

Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.St. Luke's Life Science Institute Center for Clinical Epidemiology, Tokyo, Japan.Departments of Pathology, St. Luke's International Hospital, Tokyo, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.Departments of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan.Department of Gastroenterological Surgery and Surgical Oncology, Okayama University, Okayama, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.Departments of Radiology, St. Luke's International Hospital, Tokyo, Japan.Department of Surgery, Division of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan.Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26346047

Citation

Kondo, Takafumi, et al. "A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed With Ductal Carcinoma in Situ of the Breast." Journal of Surgical Oncology, vol. 112, no. 5, 2015, pp. 476-80.
Kondo T, Hayashi N, Ohde S, et al. A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast. J Surg Oncol. 2015;112(5):476-80.
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), 476-80. https://doi.org/10.1002/jso.24037
Kondo T, et al. A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed With Ductal Carcinoma in Situ of the Breast. J Surg Oncol. 2015;112(5):476-80. PubMed PMID: 26346047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast. AU - Kondo,Takafumi, AU - Hayashi,Naoki, AU - Ohde,Sachiko, AU - Suzuki,Koyu, AU - Yoshida,Atsushi, AU - Yagata,Hiroshi, AU - Niikura,Naoki, AU - Iwamoto,Takayuki, AU - Kida,Kumiko, AU - Murai,Michiko, AU - Takahashi,Yuko, AU - Tsunoda,Hiroko, AU - Nakamura,Seigo, AU - Yamauchi,Hideko, Y1 - 2015/09/08/ PY - 2015/08/13/received PY - 2015/08/22/accepted PY - 2015/9/9/entrez PY - 2015/9/9/pubmed PY - 2016/2/18/medline KW - breast cancer KW - ductal carcinoma in situ KW - nomogram KW - sclerosing adenosis SP - 476 EP - 80 JF - Journal of surgical oncology JO - J Surg Oncol VL - 112 IS - 5 N2 - 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. SN - 1096-9098 UR - https://www.unboundmedicine.com/medline/citation/26346047/A_model_to_predict_upstaging_to_invasive_carcinoma_in_patients_preoperatively_diagnosed_with_ductal_carcinoma_in_situ_of_the_breast_ L2 - https://doi.org/10.1002/jso.24037 DB - PRIME DP - Unbound Medicine ER -