Evaluating the Risk of Upstaging HER2-Positive DCIS to Invasive Breast Cancer

Mustafa, Rose E.; DeStefano, Lauren; Bahng, Joey; Yoon-Flannery, Kahyun; Fisher, Carla S.; Zhang, Paul J.; Tchou, Julia; Czerniecki, Brian J.; Cruz, Lucy M. De La

doi:10.1245/s10434-017-5941-0

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…Monabati et al reported that HER2-positive DCIS cases were more likely to be of high nuclear grade (18). Mustafa et al reported that HER2-positive DCIS tended to be upstaged to invasive ductal carcinoma (16). However, the targets of that report were all typed as DCIS.…”

Section: Final Diagnosis --------------------------------------------mentioning

confidence: 95%

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Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

et al. 2020

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Preoperatively diagnosed ductal carcinoma in situ (DCIS) is sometimes upstaged to invasive cancer by postoperative pathological examination. Various preoperative factors associated with upstaging to invasive cancer have been reported; however, this subject remains to be clarified. DCIS takes various forms on imaging, but many cases show non-mass-type lesions. In non-mass-type DCIS, recognizing the presence of invasion is difficult. To investigate predictors associated with upstaging to invasive cancer more precisely, we examined only non-mass-type DCIS. The present study retrospectively analyzed 101 patients diagnosed with non-mass-type DCIS preoperatively on breast biopsy at our institution between 2007 and 2017. Data were analyzed using Fisher's exact probability test and two-sample t-tests. Multivariate analysis was performed using logistic regression. The results showed that 27 patients (27%) were finally diagnosed with invasive cancer. Univariate analysis revealed abnormal result of palpation on breast examination (P=0.05), comedo necrosis (P=0.05), and HER2 status (P=0.02) as significant predictors. Multivariate analysis revealed an abnormal result of palpation as an independent predictor of invasive cancer underestimation (odds ratio 4.76; confidence interval 1.44-15.7; P=0.01). In conclusion, preoperatively diagnosed non-mass-type DCIS represented an underestimation in approximately 27% of cases. In particular, the presence of a clinically abnormal palpation increases the chance of upstaging to invasive cancer.

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Section: Final Diagnosis --------------------------------------------mentioning

confidence: 95%

“…The significance of HER2 overexpression in DCIS is not well defined. However, HER2 DCIS has recently been reported as an aggressive type (16)(17)(18). Monabati et al reported that HER2-positive DCIS cases were more likely to be of high nuclear grade (18).…”

Section: Final Diagnosis --------------------------------------------mentioning

confidence: 99%

Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

et al. 2020

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“…The NCDB is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society, and all data used in this study were de-identified and met the criteria for exempt review by the University of Oklahoma Health Sciences Center Institutional Review Board (IRB# 7446). Women were selected based on a clinical stage of T1N0M0, 14 ductal histology (International Classification of Diseases for Oncology, Third Revision [ICD-O-3] codes 8022, 8035, 8500-8503, 8523), and receipt of BCS as their first treatment (Surgery of the Primary Site codes [19][20][21][22][23][24]. Only cases diagnosed and treated, all or in part, at the reporting facility were included in the final cohort.…”

Section: Cohortmentioning

confidence: 99%

Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma

et al. 2021

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Background Time to surgery (TTS) has been suggested to have an association with mortality in early-stage breast cancer. Objective This study aims to determine the association between TTS and preoperative disease progression in tumor size or nodal status among women diagnosed with clinical T1N0M0 ductal breast cancer. Methods Women diagnosed with clinical T1N0M0 ductal breast cancer who had breast-conserving surgery as their first definitive treatment between 2010 and 2016 (n = 90,405) were analyzed using the National Cancer Database. Separate multivariable logistic regression models for hormone receptor (HR)-positive and HR-negative patients, adjusted for clinical and demographic variables, were used to assess the relationship between TTS and upstaging of tumor size (T-upstaging) or nodal status (N-upstaging). Results T-upstaging occurred in 6.76% of HR-positive patients and 11.00% of HR-negative patients, while N-upstaging occurred in 12.69% and 10.75% of HR-positive and HR-negative patients, respectively. Among HR-positive patients, odds of T-upstaging were higher for 61–90 days TTS (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.05–1.34) and ≥91 days TTS (OR 1.47, 95% CI 1.17–1.84) compared with ≤30 days TTS, and odds of N- upstaging were higher for ≥91 days TTS (OR 1.35, 95% CI 1.13–1.62). No association between TTS and either T- or N-upstaging was found among HR-negative patients. Other clinical and demographic variables, including grade, tumor location, and race/ethnicity, were associated with both T- and N-upstaging. Conclusion TTS ≥61 and ≥91 days was a significant predictor of T- and N-upstaging, respectively, in HR-positive patients; however, TTS was not associated with upstaging in HR-negative breast cancer. Delays in surgery may contribute to measurable disease progression in T1N0M0 ductal breast cancer.

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“…Likewise, HER2 positivity in pure DCIS at the biopsy level seems to be associated with increased risk of synchronous invasive cancer in the subsequent resection specimen. 66 This could be due to the fact that HER2-positive invasive carcinomas have an extensive HER2-positive in situ component, 67 which is a risk factor for sampling error. However, further investigations are necessary as this upstage risk was not confirmed by others.…”

Section: Risk Assessment For Synchronous Invasion At the Biopsy Levelmentioning

confidence: 99%

“…Among them, increased stromal inflammation seems perpetually associated with increased risk for (micro‐)invasive carcinoma, but this promising histopathological feature requires further validation in larger independent patient cohorts. Likewise, HER2 positivity in pure DCIS at the biopsy level seems to be associated with increased risk of synchronous invasive cancer in the subsequent resection specimen . This could be due to the fact that HER2‐positive invasive carcinomas have an extensive HER2‐positive in situ component, which is a risk factor for sampling error.…”

Section: Introductionmentioning

confidence: 99%

A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

Bockstal

Agahozo

Koppert

et al. 2019

Intl Journal of Cancer

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Ductal carcinoma in situ (DCIS) of the breast is a nonobligate precursor of invasive breast cancer, accounting for 20 % of screen‐detected breast cancers. Little is known about the natural progression of DCIS because most patients undergo surgery upon diagnosis. Many DCIS patients are likely being overtreated, as it is believed that only around 50 % of DCIS will progress to invasive carcinoma. Robust prognostic markers for progression to invasive carcinoma are lacking. In the past, studies have investigated women who developed a recurrence after breast‐conserving surgery (BCS) and compared them with those who did not. However, where there is no recurrence, the patient has probably been adequately treated. The present narrative review advocates a new research strategy, wherein only those patients with a recurrence are studied. Approximately half of the recurrences are invasive cancers, and half are DCIS. So‐called “recurrences” are probably most often the result of residual disease. The new approach allows us to ask: why did some residual DCIS evolve to invasive cancers and others not? This novel strategy compares the group of patients that developed in situ recurrence with the group of patients that developed invasive recurrence after BCS. The differences between these groups could then be used to develop a robust risk stratification tool. This tool should estimate the risk of synchronous and metachronous invasive carcinoma when DCIS is diagnosed in a biopsy. Identification of DCIS patients at low risk for developing invasive carcinoma will individualize future therapy and prevent overtreatment.

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Evaluating the Risk of Upstaging HER2-Positive DCIS to Invasive Breast Cancer

Cited by 13 publications

References 11 publications

Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

Prolonged Time from Diagnosis to Breast-Conserving Surgery is Associated with Upstaging in Hormone Receptor-Positive Invasive Ductal Breast Carcinoma

A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast

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