title: Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: preoperative predictors of invasive breast cancer.
abstract: OBJECTIVE
  To identify preoperative features that could be used to predict invasive breast cancer in women with a diagnosis of ductal carcinoma in situ (DCIS) at ultrasound (US)-guided 14-gauge core needle biopsy (CNB).
  
  
  METHODS
  A total of 86 DCIS lesions that were diagnosed at US-guided 14-gauge CNB and excised surgically in 84 women were assessed. We retrospectively reviewed the patients' medical records, mammography, US, and MR imaging. We compared underestimation rates of DCIS for the collected clinical and radiologic variables and determined the preoperative predictive factors for upstaging to invasive cancer.
  
  
  RESULTS
  Twenty-seven (31.4%) of 86 DCIS lesions were upgraded to invasive cancer. Preoperative features that showed a significantly higher underestimation of DCIS were palpability or nipple discharge (p=0.040), number of core specimens less than 5 (p=0.011), mammographic maximum lesion size of 25 mm or larger (p=0.022), mammographic mass size of 40 mm or larger (p=0.046), sonographic mass size of 32 mm or larger (p=0.009), lesion size of 30 mm on MR (p=0.004), lower signal intensity (SI) on fat-saturated T2-weighted MR images (FS-T2WI) (p=0.005), heterogeneous or rim enhancement on MR images (p=0.009), and apparent diffusion coefficient (ADC) values lower than 1.04 × 10(-3)mm(2)/s on diffusion-weighted MR imaging (DWI) (p<0.001).
  
  
  CONCLUSIONS
  Clinical symptom of palpability or nipple discharge, number of core specimen, mammographic maximum lesion or mass size, SI on FS-T2WI, heterogeneous or rim enhancement on MR, and ADC value may be helpful in predicting the upgrade to invasive breast cancer for DCIS diagnosed at US-guided 14-gauge CNB.
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Park
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hye Mi
authors.initials: HM
authors.lastname: Gweon
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Son
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Miri
authors.initials: M
authors.lastname: Yoo
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jeong-Ah
authors.initials: JA
authors.lastname: Kim
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: jhyouk@yuhs.ac.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Youk
mesh_terms: D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Core needle biopsy; Ductal carcinoma in situ; Ultrasound