[Visibility in ultrasonography as the strongest invasion predictor in ductal carcinoma in situ in a retrospective study].
BACKGROUND
Detection of ductal carcinoma in situ (DCIS) of the breast has markedly increased since the introduction of screening mammography. Current management of this preinvasive lesion comprises complete margin-free resection of the tumour. Lymph node staging is still not indicated as a standard procedure but we can find published cases of pure DCIS with lymph node involvement as well as a high proportion of invasive carcinomas in the final histopathology. The aim of this study was to determine the proportion of invasive tumours in our group of patients operated on for DCIS, to analyse the predictive factors of invasion and to assess the frequency of lymph node metastases.


METHODS
From 2006 to 2008, a retrospective review was conducted of 179 patients operated on at Masaryk Memorial Cancer Institute for the initial diagnosis of DCIS carried out by core-needle biopsy; in 117 of them, regional lymph node staging was performed.


RESULTS
In the final histopathological results, an invasive lesion was found in 34% of cases. The expected predictive factors of invasion were statistically analysed by Fisher's exact and Chi-square test. Preoperative ultrasound-guided core-needle biopsy (p = 0.014) related to ultrasound detection of the lesion (p = 0.023) was shown to be the statistically most significant predictive factor. Mammographic character (p = 0.105) or size (p = 0.077), histopathological grade (p = 0.104), multifocality (p = 0.544) and age (p = 0.212) did not show any statistical significance. Lymph node metastases were detected in fewer than 10% of cases of invasive carcinoma. There was no detection of lymph node involvement in pure DCIS.


CONCLUSIONS
We recommend performing primary sentinel node biopsy in DCIS unambiguously detected by ultrasound and in patients treated by total mastectomy where, in the case of invasive carcinoma, subsequent identification of the sentinel node would be difficult.
Vrtelová
P
P
Oddelení chirurgické onkologie, Masarykův onkologický ústav, Brno. vrtelova@mou.cz
Coufal
O
O
Pavlík
T
T
Bazout
M
M
Fait
V
V
D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D014463:Ultrasonography