Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only

Abstract

Mammographic features and tumor size can help predict invasion in patients who have DCIS on core biopsy. Patients who have features other than calcification on mammography or have tumor size > or =5 cm should be considered for a sentinel node biopsy.

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

“…This may reflect more extensive disease that may be associated with higher chance of invasion, as has been reported by others, citing various cutoff points, including involvement of more than 15 ducts spaces, 15 or various lesional sizes, ranging from 50 to 15 mm. 7,17,21 The advantage of assessing the percentage of positive cores over size estimation or the number of positive cores is that a positive ratio is independent of the core sizes and the total number of cores obtained. It has been previously reported that inadequate (or smaller number)cores was associated with a higher upgrading rate, 13,18 although the latter study 18 also showed that core size was not related to missed invasion in the final excision.…”

“…16,21 It seems that evaluating the percentage of positive cores is more representative than merely the number of cores taken, as the former would yield a more accurate indication of the extensiveness of the lesion. In this context, one may suggest that size estimation may also be a good parameter to evaluate, as evident by the number of studies evaluating the size either pathologically 7,15,17,21 or radiologically, either using mammography 7,10,20 or ultrasound.…”

“…However, some cases of needle core biopsy-diagnosed DCISs turned out to be invasive in the final excisions. This was not an uncommon occurrence, being reported in 8-44% [7][8][9][10][11][12][13][14][15][16][17][18] of multiple series of needle core biopsy-diagnosed DCISs of the breast. It is interesting to note that the upstaging rates of several series spanning over a period of time were similar, indicating that there has not been substantial progress in the histological evaluation of predictive factors of invasion in needle core biopsy showing DCIS only.…”

“…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.…”

Regression of Ductal Carcinoma In Situ After Treatment with Acupuncture

“…[7][8][9] It is associated with risk for both locally invasive IBC and distant development of IBC. 4 As little as 5% 10 and much as 39%-59% 11 of DCIS cases are actually found to be IBC at the time of excision, and 5%-19% of DCIS recurs after excision. 12 Of these, roughly half are invasive at recurrence.…”