title: Characteristics associated with upgrading to invasiveness after surgery of a DCIS diagnosed using percutaneous biopsy.
abstract: OBJECTIVE
  Ductal carcinoma in situ (DCIS) is a non-invasive malignant breast lesion. Patients diagnosed with a DCIS on percutaneous biopsy usually undergo resection, and the final pathology may reveal that the lesion was in fact invasive (upgrading at surgery), this leading to treatment strategy change during its course. The aim of the present study was to identify factors associated with DCIS-upgrading to invasive carcinoma at surgery, and to identify a subgroup of patients more likely to have an invasive cancer.
  
  
  METHODS
  A retrospective study was performed in patients diagnosed with DCIS on percutaneous biopsy between April 1997 and December 2010. Based on available data and on previous studies, 21 clinical, radiological and pathological variables were evaluated using univariate analyses. Variables identified in univariate analyses, when p≤0.10, were included in a multivariate model.
  
  
  RESULTS
  Among 608 DCIS lesions, 177 (29.1%) were invasive carcinomas after surgery. Using univariate analyses, core needle biopsy (odds ratio (OR)=1.8), physical symptoms (OR=2.9), palpable masses (OR=4.1), number of specimen obtained (1-9 cores, OR=2.2) and a measurable mammographic lesion (OR=1.7) were significantly associated with upgrading at surgery. However, using multivariate analysis, no factor was significantly associated.
  
  
  CONCLUSIONS
  No characteristic was identified to be independently associated with DCIS upgrading at surgery, and no sub-group of patients could be identified in whom the appropriate surgery could have been performed first.
authors.affiliation: Oncology Research Unit, CHU de Québec Research Centre, 1050 chemin Ste-Foy, Quebec City, QC, Canada, G1S 4L8. caroline.diorio@uresp.ulaval.ca.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Hogue
authors.forename: Lucie
authors.initials: L
authors.lastname: Morais
authors.forename: Louise
authors.initials: L
authors.lastname: Provencher
authors.forename: Christine
authors.initials: C
authors.lastname: Desbiens
authors.forename: Brigitte
authors.initials: B
authors.lastname: Poirier
authors.forename: Éric
authors.initials: É
authors.lastname: Poirier
authors.forename: Simon
authors.initials: S
authors.lastname: Jacob
authors.forename: Caroline
authors.initials: C
authors.lastname: Diorio
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Ductal carcinoma in situ; breast cancer; percutaneous biopsy; upgrade