title: Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy.
abstract: BACKGROUND
  Diagnosis of ductal carcinoma in situ (DCIS) by core needle biopsy showed a high rate of underestimation of invasiveness, and performing sentinel lymph node biopsy (SLNB) in DCIS patients was controversial.
  
  
  METHODS
  We analyzed 340 DCIS patients who were diagnosed by needle biopsies. Final pathology and clinicopathological features were reviewed. Predictors were accessed using the Chi-square test and a binary logistic regression model.
  
  
  RESULTS
  The overall DCIS underestimation rate was 42.6%. The underestimation was significantly related to the palpability, mass or calcification by ultrasonography, grade, suspicious microinvasion, and biopsy method in univariate analysis. In multivariate analysis, palpability, ultrasonographic calcification or mass, suspicious microinvasion, and core needle biopsy were independent predictors of underestimation of invasive cancer. In cases with one or no risk predictors, the underestimation rate was 14.3%, whereas, in those with five predictors, it increased to 90.9%. Among 144 invasive cancer patients who underwent axillary staging, 15.4% had node metastasis.
  
  
  CONCLUSIONS
  DCIS diagnosed by preoperative needle biopsy has a high probability of underestimation, and 15% of invasive cancer patients have node metastasis. SLNB may be justified in DCIS patients undergoing needle biopsies, and caution should be exercised in omitting SLNB in patients with one or no risk predictors.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Seho
authors.initials: S
authors.lastname: Park
authors.forename: Junghoon
authors.initials: J
authors.lastname: Cho
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Park
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Byeong-Woo
authors.initials: BW
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008327:Mammography; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D018570:Risk Assessment; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D016217:Ultrasonography, Mammary
chemical_list: D014408:Biomarkers, Tumor