Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

Abstract

Preoperatively diagnosed ductal carcinoma in situ (DCIS) is sometimes upstaged to invasive cancer by postoperative pathological examination. Various preoperative factors associated with upstaging to invasive cancer have been reported; however, this subject remains to be clarified. DCIS takes various forms on imaging, but many cases show non-mass-type lesions. In non-mass-type DCIS, recognizing the presence of invasion is difficult. To investigate predictors associated with upstaging to invasive cancer more precisely, we examined only non-mass-type DCIS. The present study retrospectively analyzed 101 patients diagnosed with non-mass-type DCIS preoperatively on breast biopsy at our institution between 2007 and 2017. Data were analyzed using Fisher's exact probability test and two-sample t-tests. Multivariate analysis was performed using logistic regression. The results showed that 27 patients (27%) were finally diagnosed with invasive cancer. Univariate analysis revealed abnormal result of palpation on breast examination (P=0.05), comedo necrosis (P=0.05), and HER2 status (P=0.02) as significant predictors. Multivariate analysis revealed an abnormal result of palpation as an independent predictor of invasive cancer underestimation (odds ratio 4.76; confidence interval 1.44-15.7; P=0.01). In conclusion, preoperatively diagnosed non-mass-type DCIS represented an underestimation in approximately 27% of cases. In particular, the presence of a clinically abnormal palpation increases the chance of upstaging to invasive cancer.

Breast cancer in Trinidad and Tobago

“…[ 41 ] and Oda et al . [ 42 ] Necrosis 10% (n = 12) and microcalcification 3.33% (n = 4) were incidental findings in our study. None of these cases had a prior history of trauma, radiotherapy, and reduction mammoplasty or breast infection.…”

Deep‐learning model to improve histological grading and predict upstaging of atypical ductal hyperplasia / ductal carcinoma in situ on breast biopsy

“…When present on biopsy, comedonecrosis is also found to predict upstaging to invasive carcinoma. 6 In most (but not all) clinical studies, DCIS with low-or intermediate-nuclear grade was considered high-grade/high-risk if comedonecrosis was present. 18,23,24 However, there is significant variability in the diagnostic threshold for comedonecrosis regarding the extent of the duct diameter involved by necrosis.…”

“…This conservative approach has been supported by the results of a previous meta‐analysis, which concluded that even with biopsy alone, the mortality rate of patients with DCIS remained at only 17.8% within at least a 15‐year follow‐up, with a steep increase to 55.2% for those with invasive local recurrence 5 . Thus, a correct risk stratification of these precursor lesions is fundamental when planning treatment strategies, and possible predictors for upstaging ductal DCIS to invasive carcinoma have been identified, such as palpability, tumour size, radiological features, biopsy methods, and histological grading 6–9 . Nevertheless, this process is limited by the significant interobserver variability in the grading of DCIS by human pathologists, as demonstrated in previous studies 10,11 …”

“…5 Thus, a correct risk stratification of these precursor lesions is fundamental when planning treatment strategies, and possible predictors for upstaging ductal DCIS to invasive carcinoma have been identified, such as palpability, tumour size, radiological features, biopsy methods, and histological grading. [6][7][8][9] Nevertheless, this process is limited by the significant interobserver variability in the grading of DCIS by human pathologists, as demonstrated in previous studies. 10,11 Deep-learning-based computational pathology has become a powerful tool for histological diagnosis, grading, and survival prediction.…”

Magnetic resonance imaging diagnosis of non-mass enhancement of the breast

“…Oda et al reported a 27% upgrade (DCIS to IDC) for non-mass, with a higher likelihood when palpable, although imaging lexicons, including clustered rings, did not show a consistent trend [ 23 ]. Further study is necessary to determine whether the imaging lexicons suggest invasion.…”