An Updated Nomogram for Predicting Invasiveness in Preoperative Ductal Carcinoma In Situ of the Breast

Abstract

Purpose: To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy. Materials and Methods: Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous version of the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups according to the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student's t-test, and binary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index and Hosmer-Lemeshow goodness of fit test. Results: The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperative pathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% of patients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis were operation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographic mass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type, sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model with these variables showed moderate discrimination and was appropriate in the calibration test. Conclusion: The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.

Frozen sections in decision-making regarding the axillary procedures in breast conserving surgery for intraductal carcinoma at preoperative diagnosis

“…The presence of microinvasion had a 73% possibility of being invasive breast cancer on permanent pathology in a previous study [14]. Several nomograms predicting invasiveness have been published, but no uniform pattern can be noticed overall [10][11][12]. A possible reason for no signi cant difference in the value of mass size or palpability in the current study is that we only analyzed patients who underwent BCS.…”

“…The patients received into the core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) as previously described [12]. A 14-gauge semi-automatic core needle was used for CNB under ultrasonic guidance [12].…”

“…An 8-or 11-gauge vacuum-assisted large-core breast biopsy system was performed for VAB under ultrasonic or stereotactic guidance [12].…”

“…The clinicopathologic factors were determined by referring to previous studies [4,[10][11][12]. Age, lesion size, microcalci cation or mass existence on imaging study, biopsy method, and nuclear grade were considered the predictive factors for invasiveness.…”

“…The ability to predict the probability of upstaging of preoperative DCIS is bene cial for determining whether an SLNB should be performed. Several studies have reported on the prediction of the upstaging of the preoperative DCIS, such as identi cation of predictive factors or establishing nomograms [4,[10][11][12]. As part of these efforts, we evaluated the role of intraoperative frozen section (IOF) biopsy of tumors in identi cation of the upstaging of DCIS to invasive cancer in patients with preoperative DCIS.…”