Factors Associated With Underestimation of Invasive Cancer in Patients With Ductal Carcinoma In Situ

Villanueva, Carlos Chavez de Paz; Bonev, Valentina; Senthil, Maheswari; Solomon, Naveenraj L.; Reeves, Mark E.; Garberoglio, Carlos A.; Namm, Jukes P.; Lum, Sharon S.

doi:10.1001/jamasurg.2017.2181

Cited by 29 publications

(31 citation statements)

References 31 publications

(112 reference statements)

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“…The underestimation rate of 24.4% found in our study was similar to that reported in the literature. 21 , 22 During the study period, vacuum biopsy (mammotomy), which uses larger caliber needles (9 gauge) and enables greater precision, was not available at the clinic. The high cost of the mammotomy needle device limits access to this technique in Brazilian public institutions.…”

Section: Discussionmentioning

confidence: 99%

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

Sá¹,

Logullo²,

Elias³

et al. 2021

BCTT

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Background Mammography screening has become widely spread and provided a marked increase in ductal carcinoma in situ (DCIS) diagnosis. In DCIS, the ductal epithelium proliferates without invasion through the basal cell membrane. However, histologic underestimation can happen in some cases. Objective To analyze the rate of histologic underestimation (histopathologic results upgraded to invasive carcinoma after surgery) and the rate of positive results of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS in a Brazilian public hospital. Methods We reviewed medical records of all consecutive patients admitted between 2009 and 2013 whose initial diagnosis was DCIS through core needle biopsy. DCIS cases with a high risk of invasion underwent SLNB. We excluded cases with invasion or micro-invasion components in the first biopsy. Results A total of 86 women were included, most with microcalcifications as the primary radiological lesion (73.2%), and underwent preoperative biopsy, with an invasive component in 21 (24.4%) in the final pathology report. Most had invasive carcinoma of no special type (NST): 52.3% (n = 11) and microinvasive tumors (7 cases, 33.3%). The main factors associated with histologic underestimation were nodular lesion (61.9%, p<0.001) and an ultra-sonography-guided biopsy (71.4%, p=0.0005). The positivity rate of SLNB was 4.3%. All these patients underwent mastectomy, and the initial histologic pattern was solid DCIS. Conclusion The “histologic underestimation” rate among patients with DCIS was not low, and less than 5% of patients who underwent SLNB had axillary positivity. This result suggests that patients who have DCIS and a high risk of invasion and undergoing mastectomy should have SLNB. As to the patients who will undergo lumpectomy, SLNB could be omitted and could be performed if patients have upgraded to invasive breast cancer.

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Section: Discussionmentioning

confidence: 99%

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

Sá¹,

Logullo²,

Elias³

et al. 2021

BCTT

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“…One of the main concerns HCPs expressed in this study was around the uncertainty in accurately diagnosing DCIS based on imaging and core biopsy alone. Studies have estimated that diagnostic core biopsies in non-high grade DCIS underestimate invasive cancer by 8–22% [ [31] , [32] , [33] ]. HCPs explained that surgery and the associated full pathology ameliorates uncertainty around the extent and true features of the DCIS.…”

Section: Discussionmentioning

confidence: 99%

Views of healthcare professionals about the role of active monitoring in the management of ductal carcinoma in situ (DCIS): Qualitative interview study

et al. 2020

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Background Ductal carcinoma in situ (DCIS) is an in-situ (pre-cancerous) breast malignancy whereby malignant cells are contained within the basement membrane of the breast ducts. Increasing awareness that some low-risk forms of DCIS might remain indolent for many years has led to concern about overtreatment, with at least 3 clinical trials underway internationally assessing the safety of active monitoring for low-risk DCIS. This study aimed to understand healthcare professionals’ (HCPs) views on the management options for patients with DCIS. Methods Qualitative study using semi-structured interviews with HCPs involved in the diagnosis and management of DCIS in Australia and New Zealand. Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis method. Results Twenty-six HCPs including 10 breast surgeons, 3 breast physicians, 6 radiation oncologists, and 7 breast care nurses participated. There was a strong overall consensus that DCIS requires active treatment. HCPs generally felt uncomfortable recommending active monitoring as a management option for low-risk DCIS as they viewed this as outside current standard care. Overall, HCPs felt that active monitoring was an unproven strategy in need of an evidence base; however, many acknowledged that active monitoring for low-risk DCIS could be appropriate for patients with significant co-morbidities or limited life expectancy. They believed that most patients would opt for surgery wherever possible. Conclusions This study highlights the important need for robust randomised controlled trial data about active monitoring for women with low-risk DCIS, to provide HCPs with confidence in their management recommendations and decision-making.

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“…Besides, overdiagnosis and overtreatment are emerging issues in DCIS patients diagnosed via breast cancer screening. Therefore, in patients diagnosed with DCIS through biopsy, prediction of invasive cancer seems essential for selecting breast cancer treatment options (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies have been carried out to define the clinicopathological characteristics associated with an upgrade to invasive cancer in patients preoperatively diagnosed with DCIS (5)(6)(7)(9)(10)(11)(12)(13)(14)(15). The possible predictors include the patient's age, palpability, tumor size, tumor grade, biopsy method, and some immunohistochemi-Copyright © 2021, Author(s).…”

Section: Introductionmentioning

confidence: 99%

Role of FDG-PET/CT in Identification of Histological Upgrade of Ductal Carcinoma in Situ (DCIS) in Needle Biopsy

et al. 2021

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Background: Accurate preoperative detection of the invasive components of ductal carcinoma in situ (DCIS) is essential for an appropriate treatment. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan, which can indicate the metabolic activity and aggressiveness of breast cancer, may be used as one of the predictors of the invasive components of DCIS in needle biopsy. Objectives: To determine whether the FDG-PET/CT findings are associated with the histological upgrade of DCIS in biopsy. Methods: In this retrospective cohort, we reviewed 165 cases of DCIS in 162 patients, who underwent preoperative FDG-PET/CT examinations between April 2008 and September 2015. The clinicopathological characteristics and FDG-PET/CT findings of the patients were compared with respect to cancer invasion. The predictors of DCIS upgrade to invasive cancer were also examined. Moreover, the diagnostic performance of visual and semi-quantitative analyses of FDG-PET/CT in predicting invasion was compared, based on the maximum standardized uptake value (SUVmax), divided by the cutoff point in a receiver operating characteristic (ROC) curve analysis. Results: The final pathological findings indicated 119 cases of pure DCIS and 46 cases of DCIS with invasion. The optimal SUVmax threshold was 1.9 in the ROC curve analysis. Young age, high SUVmax, positivity in the visual analysis of FDG-PET/CT, and large pathological tumor size were significantly more frequent in the DCIS + invasion group. The significant predictors of DCIS histological upgrade were age (P = 0.011), SUVmax (P < 0.001), visual analysis of FDG-PET/CT (P = 0.004), and pathological tumor size (P = 0.003) in the univariate analysis. In the multivariate analysis, the SUVmax (odds ratio [OR] = 3.31, P = 0.003) and tumor size (OR = 1.20, P = 0.022) were significant when the model included the SUVmax, age, and size (model 1). On the other hand, age (OR = 0.96, P = 0.032), visual analysis (OR = 4.67, P = 0.006), and tumor size (OR = 1.25, P = 0.005) were significant predictors when the model included visual analysis, age, and size (model 2). The sensitivity was significantly higher in the visual analysis, whereas the specificity, positive predictive value (PPV), and accuracy were significantly higher in the semi-quantitative analysis. Conclusion: FDG-PET/CT is a potentially useful imaging tool to predict the upgrade of DCIS to invasive cancer.

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Factors Associated With Underestimation of Invasive Cancer in Patients With Ductal Carcinoma In Situ

Cited by 29 publications

References 31 publications

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

Views of healthcare professionals about the role of active monitoring in the management of ductal carcinoma in situ (DCIS): Qualitative interview study

Role of FDG-PET/CT in Identification of Histological Upgrade of Ductal Carcinoma in Situ (DCIS) in Needle Biopsy

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