Predicting invasion in patients with DCIS in the preoperative percutaneous biopsy

Leikola, Junnu; Heikkilä, Päivi; Pamilo, M.; Salmenkivi, Kaisa; Smitten, Karl von; Leidenius, Marjut

doi:10.1080/02841860601128941

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…Whether these factors are totally insignificant is still debatable, as all of these had been shown to be significant or insignificant in different series. For instance, some studies showed that age, 16 number of cores, 16,21 grade, [7][8][9]11,16,21 architecture, 7,16,21 necrosis, 9,11,16,21 periductal stromal fibrosis or desmoplasia [14][15][16]21 and calcification 16,18 were insignificant, whereas other studies showed the same factors, including number of cores, 13,18 grade, 10,14,15,20 comedo necrosis, 10,11,19 and periductal inflammatory cells infiltrate, 14 to be significant. It seems that prediction of eventual invasion in needle core biopsy showing only DCIS is still fraught with uncertainty.…”

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confidence: 91%

“…Many of these series evaluated various factors, but so far no single factor stood out to be a consistent predictor. The factors that had been evaluated could be categorized as radiological features (mass, density, radiologic extent as measured using mammography or sonography, and the extent and morphology of the calcifications), 8,10,13,14,16,19 histological features (size, grade, necrosis, calcifications, architecture, lobular extension, periductal inflammation and periductal stromal fibrosis), [7][8][9][10]12,[14][15][16][18][19][20][21] sampling adequacy as indicated by the number of cores sampled 16,18 and patient factor, such as age. 10,16 There were reports that either confirmed or refuted their roles as predictors for invasion in needle core biopsy showing DCIS only.…”

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confidence: 99%

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Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Chan

Vong

et al. 2010

Modern Pathology

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A significant proportion of ductal carcinomas in situ (DCISs) of the breast diagnosed on core biopsies had invasion upon excision. An assessment of various invasion predictors in the biopsies yielded conflicting results. A cohort of 157 cases with needle core biopsy diagnosed with DCISs (including 109 histologically proven DCISs, and 48 cases with invasion upon excision) were evaluated for the numbers of positive and total cores, the percentage of positivity, lobular cancerization, tumor nuclear grade, necrosis, calcification, predominate histological pattern, lymphocytic infiltrate and excisional tumor size. The mean positive core percentage and excisional tumor size were 76% and 2.8 cm for invasive and 66% and 1.9 cm for noninvasive groups. In the biopsy of the invasive group, cancerization of lobules was present in 52%, and nuclear grades 1, 2 and 3 were present in 31, 31 and 38%, respectively. Large comedo and small noncomedo necroses were present in 48 and 10%, whereas large and small calcifications were present in 16 and 21%. Solid, cribriform and papillary patterns were observed in 88, 38 and 21%, respectively. Moderate to marked lymphoid infiltrate was present in 31%. In the biopsy of the noninvasive group, cancerization of lobules was present in 69%, and the nuclear grades 1, 2 and 3 were present in 23, 48 and 29%, respectively. Large comedo and small noncomedo necroses were present in 35 and 11%, whereas large and small calcifications were present in 33 and 23%. Solid, cribriform and papillary patterns were observed in 85, 39 and 9%, respectively. Moderate to marked lymphoid infiltrate was present in 36%. Comparing these groups, a higher positive core percentage, papillary pattern and less cancerization of lobules in the cores and larger excisional tumor size were associated with a higher chance of invasion. Calcification, necrosis and nuclear grade were not significant invasion predictors.

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confidence: 91%

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confidence: 99%

Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Chan

Vong

et al. 2010

Modern Pathology

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“…Nevertheless, it appeared that the extent of the disease as indicated by the percentage of positive cores was a reasonable predictor [30,31,34,37]. Of interest was also that nuclear grade, necrosis and calcification (comedo or non comedo) had not been shown to be unanimous predictors for invasion, with studies confirming [30,33,34,38,39] and refuting [31,37,40] these factors. Thus, currently there is still no reliable invasion predictor for CNB showing only DCIS.…”

Section: Can Cnb Showing Only Dcis Reliably Rule Out Whole Tumor Invamentioning

confidence: 92%

“…In studies that addressed this issue, some showed no explicit difference in the core biopsy histology of these two groups [30,38]. On the other hand, in a series of micro-invasive breast carcinoma, the majority (72%) of them were associated with carcinoma in situ in biopsy (more high grade than low grade), with the remaining cases associated with atypical duct hyperplasia (17%) only or benign pathology (11%) [41].…”

Section: Can Cnb Showing Only Dcis Reliably Rule Out Whole Tumor Invamentioning

confidence: 99%

Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better?

Tse

Tan

2010

Breast Cancer Res Treat

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Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) are widely used in diagnosing breast lesions, with both achieving high sensitivity and specificity. Whether FNAC or CNB is better remains highly controversial. In this review, the advantages and disadvantages of each of these methods are discussed, especially in relation to specific problematic groups of breast lesions. In general, CNB has a slight advantage with lower inadequate and suspicious rates, allowing easier grade assessment and ancillary testings (hormome receptors, HER2) in cases of cancers. FNAC cannot reliably predict invasion in a malignant aspirate, whereas CNB, although useful in confirming invasion in carcinomas, has a much lower efficacy in predicting invasion when only in situ carcinoma is detected. The other problematic areas are papillary breast lesions and fibroepithelial lesions, notably phyllodes tumors. In papillary lesions, FNAC diagnosis is inaccurate, but with CNB, one can confidently diagnose papillary lesion, although there is still significant false positive and false negative rates, even with immunohistochemistry. For fibroepithelial lesions, using either FNAC or CNB to differentiate between a phyllodes tumor from fibroadenoma is also inaccurate. As management of breast diseases necessitates the triple approach (clinical, imaging and pathological), an awareness of the limitations of these very useful diagnostic modalities by all specialists is prudent, especially when dealing with these specific groups of breast lesions.

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“…Although some have failed to identify any reliable predictor [6], in the majority of the studies variables of predictive value have been found; these refer to different clinicopathologic items such as the age of the patient [7], the palpability of the lesion [8–12], the characteristics of the lesion on imaging methods (mass/microcalcifications/others) [8–10, 12–15], the size of the lesion [7, 10, 11, 14], the type of biopsy (core cut/vacuum assisted/excisional) [7, 8, 16], and histopathologic findings in the biopsy specimen (proportion of affected ducts, grade, suspicious invasion) [7, 8, 10, 12]. A more detailed review of the literature on this topic has been published by Brennan et al [1].…”

Section: Introductionmentioning

confidence: 99%

A Simple Model to Assess the Probability of Invasion in Ductal Carcinoma In Situ of the Breast Diagnosed by Needle Biopsy

Coufal

Selingerová

Vrtělová

et al. 2014

BioMed Research International

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Objectives. The aim of the study was to develop a clinical prediction model for assessing the probability of having invasive cancer in the definitive surgical resection specimen in patients with biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast, to facilitate decision making regarding axillary surgery. Methods. In 349 women with DCIS, predictors of invasion in the definitive resection specimen were identified. A model to predict the probability of invasion was developed and subsequently simplified to divide patients into two risk categories. The model's performance was validated on another patient population. Results. Multivariate logistic regression revealed four independent predictors of invasion: (i) suspicious (micro)invasion in the biopsy specimen; (ii) visibility of the lesion on ultrasonography; (iii) size of the lesion on mammography >30 mm; (iv) clinical palpability of the lesion. The actual frequency of invasion in the high-risk patient group in the test and validation population was 52.6% and 48.3%, respectively; in the low-risk group it was 16.8% and 7.1%, respectively. Conclusion. The model proved to have good performance. In patients with a low probability of invasion, an axillary procedure can be omitted without a substantial risk of additional surgery.

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Predicting invasion in patients with DCIS in the preoperative percutaneous biopsy

Cited by 13 publications

References 19 publications

Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better?

A Simple Model to Assess the Probability of Invasion in Ductal Carcinoma In Situ of the Breast Diagnosed by Needle Biopsy

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