title: Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision.
abstract: OBJECTIVE
  The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision.
  
  
  METHODS
  We enrolled 506 female CNB-diagnosed DCIS patients who underwent subsequent surgical excision between January 2000 and February 2011. A retrospective analysis of patients undergone core needle biopsy and subsequent surgical excision was performed. Ultrasonography guided CNB was performed using either an 8-, 11-gauge vacuum-assisted method, or a 14-gauge needle automated gun method.
  
  
  RESULTS
  The overall upstaging rate was 42.7% (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables). We designed a scoring system to predict lymph node positivity in these patients, and the subsequent ROC curve showed an AUC value of 0.746 (p < 0.001, 95% CI: 0.66-0.82). Patient with a non-high grade lesion that was ≤20 mm in size carried no risk of lymph node positivity.
  
  
  CONCLUSIONS
  Upstaging was associated with lesions that were large, palpable or high grade. It was also associated with use of the 14-gauge needle method. Our scoring system might be helpful to identify patients who do not require sentinel lymph node biopsy.
authors: Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Jisun
authors: J
authors: Kim
authors: Wonshik
authors: W
authors: Han
authors: Jong Won
authors: JW
authors: Lee
authors: Jee-Man
authors: JM
authors: You
authors: Hee-Chul
authors: HC
authors: Shin
authors: Soo Kyung
authors: SK
authors: Ahn
authors: Hyeong-Gon
authors: HG
authors: Moon
authors: Nariya
authors: N
authors: Cho
authors: Woo Kyung
authors: WK
authors: Moon
authors: In-Ae
authors: IA
authors: Park
authors: Dong-Young
authors: DY
authors: Noh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D047368:Tumor Burden; D016217:Ultrasonography, Mammary