Risk Factors for Invasive Breast Cancer When Core Needle Biopsy Shows Ductal Carcinoma In Situ

Abstract

The risk of upstaging can be estimated by using preoperative features in patients with DCIS on CNB. We propose a management algorithm that includes sentinel node biopsy for patients with DCIS who have microinvasion on CNB, palpable DCIS, 2 or more predictive factors, and planned total mastectomy.

Factors associated with upstaging of ductal carcinoma in situ diagnosed by core needle biopsy using imaging guidance

“…Although the management of DCIS with microinvasion remains controversial, sentinel lymph node biopsy is usually recommended. 9 No mammographic features were associated with upstaging in the present study, a fi nding similar to that of previous studies. 10,11 The present study found no correlation between the size of the lesion, as seen by US or mammography, and upstaging.…”

“…A preoperative diagnosis of invasive breast carcinoma associated with DCIS is important because routine axillary lymph node dissection is not recommended for the treatment of DCIS. 4,[8][9][10] Accurate preoperative diagnosis provides the opportunity for the patient to undergo a single-stage, more appropriate operation if invasive disease is identifi ed on CNB or is predicted to exist.…”

“…It was previously found that microinvasion was the strongest risk factor for DCIS upstaging. 9 Because the present study wanted to focus only on pure DCIS, patients who had DCIS with microinvasion on CNB were excluded. The rate of axillary lymph node involvement in patients with DCIS and microinvasion is in the range of 0%-17%, 9 which is low but not negligible.…”

“…9 Because the present study wanted to focus only on pure DCIS, patients who had DCIS with microinvasion on CNB were excluded. The rate of axillary lymph node involvement in patients with DCIS and microinvasion is in the range of 0%-17%, 9 which is low but not negligible. Although the management of DCIS with microinvasion remains controversial, sentinel lymph node biopsy is usually recommended.…”

DCIS does not need treatment… really?

“…In the situation where there are extensive calcifications and a core showing DCIS, excision will have cosmetic consequences, but without excising, the tumor you will not be able to confirm that 100 % of the calcifications represent DCIS. A non-surgical approach runs the risk of leaving invasive cancer untreated [22].…”