A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-Grade Ductal Carcinoma In Situ of the Breast

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: A total of 3100 VABBs were retrospectively reviewed, among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients’ features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate and multivariate analysis. Finally, we developed a nomogram for predicting the upstage at surgery, according to the multivariate logistic regression model. Results: The overall upgrade rate to invasive carcinoma was 10.8%. At univariate analysis, the risk of upgrade was significantly lower in patients with greater age (p = 0.018), without post-biopsy residual lesion (p < 0.001), with a smaller post-biopsy residual lesion size (p < 0.001), and in the presence of low-grade DCIS only in specimens with microcalcifications (p = 0.002). According to the final multivariable model, the predicted probability of upstage at surgery was lower than 2% in 58 patients; among these 58 patients, only one (1.7%) upstage was observed, showing a good calibration of the model. Conclusions: An easy-to-use nomogram for predicting the upstage at surgery based on radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

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A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-grade Ductal Carcinoma In Situ of the Breast

10.20944/preprints202111.0301.v1 ◽

2021 ◽

Author(s):

Luca Nicosia ◽

Anna Carla Bozzini ◽

Silvia Penco ◽

Chiara Trentin ◽

Maria Pizzamiglio ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Univariate Analysis ◽

Surgical Excision ◽

Low Grade ◽

Multivariable Model

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: 3100 VABBs were retrospectively reviewed among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients’ features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate analysis. Finally, we developed a predictive multivariable model based on the features which were significantly associated with the univariate analysis outcome. Results: the upgrade rate to invasive carcinoma was 10.8 %. At univariate analysis, the risk of upgrade was significantly lower in the absence of post- biopsy residual lesion (p<0.001), age > 50 (p=0.029), and in presence of low-grade DCIS only in specimens with microcalcifications (p=0.002). According to the final multivariable model, the predicted probability of diagnostic underestimation for a patient with all the three favourable features selected at univariate analysis was 1% (95% CI: 0.3%-4%). Conclusions: An easy to use predictive model of radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

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Is Ductal Carcinoma in Situ with “Possible Invasion” More Predictive of Invasive Carcinoma than Pure Ductal Carcinoma in Situ?

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2010.10.002 ◽

2012 ◽

Vol 63 (2) ◽

pp. 146-152 ◽

Cited By ~ 3

Author(s):

Tal Arazi-Kleinman ◽

Petrina A. Causer ◽

Sharon Nofech-Mozes ◽

Roberta A. Jong

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Clinical Indication ◽

Low Grade ◽

High Grade ◽

Sample Number

Objectives To compare the underestimation of ductal carcinoma in situ (DCIS) vs DCIS with “possible invasion” at breast biopsy and to determine if any factors related to clinical indication, imaging abnormality, biopsy, or DCIS-grade affected the likelihood of underestimation. Methods Of 3836 consecutive lesions that were biopsied by using a 14-gauge needle, 117 lesions revealed DCIS. Surgical pathology results of invasive carcinoma were compared with needle biopsy results of DCIS or DCIS with possible invasion. Clinical indication, imaging abnormality, biopsy guidance modality, sample number, and histologic grade were recorded. Yates corrected χ2 and Fisher exact tests were used to determine differences between groups. Results A total of 101 lesions were DCIS and 16 were DCIS with possible invasion at biopsy. Thirty-six of 117 lesions (31%) revealed invasive carcinoma at resection pathology. Invasive carcinoma was present more often when DCIS with possible invasion was diagnosed compared with pure DCIS (7/16 [44%] vs 29/101 [29%], P = .36). No factor, including clinical indication, imaging abnormality, biopsy guidance method, sample number, or grade, was found to significantly affect the likelihood of underestimation for lesions diagnosed as DCIS vs DCIS with “possible invasion.” The likelihood of pure DCIS underestimation significantly increased when lesions were high grade compared with either intermediate or low grade (18/44 [41%] vs 9/44 [21%] vs 2/10 [20%], P = .03). Conclusion For lesions biopsied by using a 14-gauge needle, there is a trend towards underestimation of the presence of invasive carcinoma when pathology reveals DCIS with possible invasion compared with pure DCIS. High-grade DCIS was significantly more likely to be underestimated.

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Active Surveillance in the Management of Ductal Carcinoma in Situ: The Radiologist’s Point of View

10.20944/preprints202012.0806.v1 ◽

2020 ◽

Author(s):

Luca Nicosia ◽

Giuseppe di Giulio ◽

Anna Carla Bozzini ◽

Marianna Fanizza ◽

Francesco Ballati ◽

...

Keyword(s):

Active Surveillance ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Surgical Excision ◽

Complete Removal ◽

Low Grade ◽

Residual Lesion

(1) Background: Considering highly selected patients with ductal carcinoma in situ (DCIS), active surveillance is a valid alternative to surgery. Our study is aimed at showing the reliability of post-biopsy complete lesion removal, documented by mammogram, as additional criterion to select these patients. (2) Methods: 2173 Vacuum Assisted Breast Biopsies (VABB) documented as DCIS have been reviewed. Surgery has been performed in all cases. We retrospectively collected the reports of post-VABB complete lesion removal and the histological results of the biopsy and surgery. We calculated the rate of upgrade of DCIS identified on VABB upon excision for patients with post-biopsy complete lesion removal and for those showing residual lesion. (3) Results: We observed 2173 cases of DCIS: 408 classified as low grade; 1262 as intermediate grade; 503 as high grade. The overall upgrading rate to invasive carcinoma was 15.2% (330/2173). The upgrade rate was significantly lower (8.2%) when considering patients showing mammographically documented complete removal of the lesion. (4) Conclusion: The absence of mammographically documented residual lesion following VABB is associated to a lower upgrading rate of DCIS to invasive carcinoma on surgical excision and should be considered when deciding the proper management DCIS diagnosis.

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Complete Removal of the Lesion as a Guidance in the Management of Patients with Breast Ductal Carcinoma In Situ

Cancers ◽

10.3390/cancers13040868 ◽

2021 ◽

Vol 13 (4) ◽

pp. 868 ◽

Cited By ~ 1

Author(s):

Luca Nicosia ◽

Giuseppe di Giulio ◽

Anna Carla Bozzini ◽

Marianna Fanizza ◽

Francesco Ballati ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Surgical Excision ◽

Complete Removal ◽

Low Grade ◽

Residual Lesion ◽

Histological Results

Background: Considering highly selected patients with ductal carcinoma in situ (DCIS), active surveillance is a valid alternative to surgery. Our study aimed to show the reliability of post-biopsy complete lesion removal, documented by mammogram, as additional criterion to select these patients. Methods: A total of 2173 vacuum-assisted breast biopsies (VABBs) documented as DCIS were reviewed. Surgery was performed in all cases. We retrospectively collected the reports of post-VABB complete lesion removal and the histological results of the biopsy and surgery. We calculated the rate of upgrade of DCIS identified on VABB upon excision for patients with post-biopsy complete lesion removal and for those showing residual lesion. Results: We observed 2173 cases of DCIS: 408 classified as low-grade, 1262 as intermediate-grade, and 503 as high-grade. The overall upgrading rate to invasive carcinoma was 15.2% (330/2173). The upgrade rate was 8.2% in patients showing mammographically documented complete removal of the lesion and 19% in patients without complete removal. Conclusion: The absence of mammographically documented residual lesion following VABB was found to be associated with a lower upgrading rate of DCIS to invasive carcinoma on surgical excision and should be considered when deciding the proper management DCIS diagnosis.

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