Upgrade Rate of Ductal Carcinoma In Situ to Invasive Carcinoma and the Clinicopathological Factors Predicting the Upgrade Following a Mastectomy: A Retrospective Study

Abstract

BackgroundThe rate of upgrading ductal carcinoma in situ (DCIS) to invasive cancer varies widely in the literature with no consensus regarding sentinel lymph node biopsy (SLNB) for DCIS; however, some guidelines do recommend it in the event of a mastectomy. The primary aim of this study was to determine the upgrade rate of DCIS to invasive carcinoma (IC) in patients undergoing mastectomy for DCIS and identify the clinicopathological predicting factors for the upgrade. The secondary aim was to determine the SLNB positivity rate. MethodologyWe retrospectively analysed consecutive patients with DCIS diagnosed through a biopsy who then underwent mastectomy over a 10-year period (2010 to 2020). Clinical, radiological, and histological variables were collected from medical records. ResultsWe studied 143 women (mean age = 57.4 years, range = 26-85 years) who underwent mastectomy for DCIS identified on biopsy. Almost two-thirds (62.9%, 90/143) of the patients were detected on screening mammography, while 35.6% (51/143) were diagnosed following presentation with either an area of palpable concern or nipple discharge. The most common mammographic presentation of DCIS was calcification (83.9%, 120/143), and, in 85.9% of the patients, the mammographic lesion was more than 20 mm. Highgrade DCIS was noted in 76.9% of preoperative biopsy results, while the rest was either low or intermediategrade DCIS. Overall, 24.5% (35/143) were upgraded to IC (upgraded group) on postoperative histology, whereas 108/143 remained DCIS postoperatively (pure DCIS group). The positivity rate of SLNB was 4.8%. Multifocality was the only significant predictor of IC on multivariate analyses of clinicopathological predictors (odds ratio = 3.0, 95% confidence interval = 1.0-8.7). The presence of comedonecrosis was higher in the upgraded group compared to the pure DCIS group (42.9% vs. 27.8%), but this was not statistically significant. ConclusionsIn our study cohort, nearly one in four (24.5%) patients were upgraded from DCIS to IC on postoperative histology, with an SLNB positivity rate of 4.8%. This is important when counselling patients regarding the risk of coincident occult IC and the importance of SLNB at the time of mastectomy. Multifocality on preoperative imaging was the only significant predictive factor. Based on this result, we recommend that SLNB should also be considered if patients have multifocal DCIS and planned for oncoplastic breastconserving surgery. However, further studies are required to investigate the association between multifocal DCIS and the risk of upgrading to IC.

De-escalation of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma In Situ

“…In this study, we evaluated patients with DCIS diagnosed on core biopsy who subsequently underwent primary surgery and SLNB. We found the upstage rate of invasive cancer to be 35.3%, and this corresponds with the 8-48% range reported in the literature [9][10][11][12][13]. This variation can be due to the heterogeneity of DCIS and the interpretation of factors by the pathologist [10].…”

“…We found the upstage rate of invasive cancer to be 35.3%, and this corresponds with the 8-48% range reported in the literature [ 9 - 13 ]. This variation can be due to the heterogeneity of DCIS and the interpretation of factors by the pathologist [ 10 ]. The rate of SLN positivity among these upstaged patients was 9.23%, and this is similar to what previous studies reported in the literature, ranging between 4-15% [ 3 , 9 , 13 , 14 ].…”

Survival Outcomes Based on Axillary Surgery in Ductal Carcinoma In Situ: A Nationwide Study From the Korean Breast Cancer Society

“…Moreover, Dutch guidelines recommend conducting SLNB in cases of high-risk invasion, irrespective of the selected breast surgical method. High-risk features included tumor size exceeding 2.5 cm, grade 3 DCIS, extensive calcifications, and age < 55 years [ 13 ].…”

“…In reality, the rate of axillary lymph node metastasis in patients with pure DCIS is < 2%. Furthermore, 13.3%–37.9% of cases diagnosed with DCIS after surgical resection and upon final pathological examination are upgraded to microinvasive carcinoma [ 9 10 11 12 13 14 15 ]. This indicates the possibility of lymph node involvement, which may be overlooked if an SLNB is not performed.…”

Effect of Invasive Ductal Carcinoma on Some Physiological and Immunological Parameters in Women with Breast Cancer

“…The results of the current study indicated that invasive ductal carcinoma is the most prevalent type of breast cancer with a rate of 86.7%, followed by invasive lobular carcinoma with a rate of 13.3% within the sample studied, and this is proven by the majority of studies, as it indicated that the percentage of invasive ductal carcinoma ranges from approximately 50% to 80%. While it indicated that the percentage of invasive lobular carcinoma is approximately 20% of cancer cases (Al-Ishaq et al, 2023), Invasive ductal carcinoma which is the most common type of breast cancer, refers to the uncontrolled growth of cancer cells, which originate from the milk ducts present in the breast tissue.…”