A model to predict upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ of the breast.
BACKGROUND
The aims of this study were to determine clinicopathological factors associated with postoperative upstaging to invasive carcinoma in patients preoperatively diagnosed with ductal carcinoma in situ (DCIS) and to develop a model to predict the risk of upstaging.


METHODS
Pre- and post-operative pathological diagnoses and radiological findings were assessed for 1,187 consecutive patients.


RESULTS
Of the patients, 306 (25.8%) were upstaged on the surgical specimen. In multivariate analysis, the following four factors were significantly associated with upstaging: 1) the presence of sclerosing adenosis on the preoperative biopsy specimen (odds ratio [OR] 0.46, P = 0.013); 2) pleomorphic calcifications on the mammogram (OR 1.68, P = 0.009); 3) a mass suspicious for invasive carcinoma on ultrasonography and/or MRI (OR 2.13, P < 0.001); 4) tumor size ≥2 cm on ultrasonography (OR 1.80, P = 0.032). HER2-positive (OR 1.54, P = 0.062) and comedo necrosis (OR 1.42, P = 0.056) demonstrated a trend towards significance. A prediction model incorporating these variables demonstrated that the risk of upstaging was 5.1% with score 0-2 and was 58.1% with score 10.


CONCLUSIONS
The prediction model incorporating clinicopathological features may be used to guide the selection of patients with DCIS for sentinel lymph node biopsy.
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Takafumi
T
Kondo
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Naoki
N
Hayashi
St. Luke's Life Science Institute Center for Clinical Epidemiology, Tokyo, Japan.
Sachiko
S
Ohde
Departments of Pathology, St. Luke's International Hospital, Tokyo, Japan.
Koyu
K
Suzuki
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Atsushi
A
Yoshida
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Hiroshi
H
Yagata
Departments of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Naoki
N
Niikura
Department of Gastroenterological Surgery and Surgical Oncology, Okayama University, Okayama, Japan.
Takayuki
T
Iwamoto
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Kumiko
K
Kida
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Michiko
M
Murai
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Yuko
Y
Takahashi
Departments of Radiology, St. Luke's International Hospital, Tokyo, Japan.
Hiroko
H
Tsunoda
Department of Surgery, Division of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan.
Seigo
S
Nakamura
Departments of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
Hideko
H
Yamauchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D015233:Models, Statistical; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D055815:Young Adult
breast cancer; ductal carcinoma in situ; nomogram; sclerosing adenosis