Surgical Outcome of Patients with Core-Biopsy-Proven Nonpalpable Breast Carcinoma: A Large Cohort Follow-Up Study

Esser, Stijn van; Peters, Niek A.; Bosch, Maurice A.A.J. van den; Mali, Willem P.Th.M.; Peeters, Petra H.M.; Rinkes, Inne H.M. Borel; Hillegersberg, Richard van

doi:10.1245/s10434-009-0513-6

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…Most of the previously published studies did not report follow up of patients after the first surgery, except for Leikola et al [21]. Since approximately 40% of women with DCIS need more than one surgery before final treatment is achieved [49], the extended follow-up time is a major strength in our study. Finally, we used multiple imputation to impute the missing data in our dataset, which decreases the chance of selection bias and provides the most reliable estimates as compared to complete case analysis or single imputation techniques [45,46].…”

Section: Discussionmentioning

confidence: 94%

Development and Evaluation of a Prediction Model for Underestimated Invasive Breast Cancer in Women with Ductal Carcinoma In Situ at Stereotactic Large Core Needle Biopsy

et al. 2013

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BackgroundWe aimed to develop a multivariable model for prediction of underestimated invasiveness in women with ductal carcinoma in situ at stereotactic large core needle biopsy, that can be used to select patients for sentinel node biopsy at primary surgery.MethodsFrom the literature, we selected potential preoperative predictors of underestimated invasive breast cancer. Data of patients with nonpalpable breast lesions who were diagnosed with ductal carcinoma in situ at stereotactic large core needle biopsy, drawn from the prospective COBRA (Core Biopsy after RAdiological localization) and COBRA2000 cohort studies, were used to fit the multivariable model and assess its overall performance, discrimination, and calibration.Results348 women with large core needle biopsy-proven ductal carcinoma in situ were available for analysis. In 100 (28.7%) patients invasive carcinoma was found at subsequent surgery. Nine predictors were included in the model. In the multivariable analysis, the predictors with the strongest association were lesion size (OR 1.12 per cm, 95% CI 0.98-1.28), number of cores retrieved at biopsy (OR per core 0.87, 95% CI 0.75-1.01), presence of lobular cancerization (OR 5.29, 95% CI 1.25-26.77), and microinvasion (OR 3.75, 95% CI 1.42-9.87). The overall performance of the multivariable model was poor with an explained variation of 9% (Nagelkerke’s R 2), mediocre discrimination with area under the receiver operating characteristic curve of 0.66 (95% confidence interval 0.58-0.73), and fairly good calibration.ConclusionThe evaluation of our multivariable prediction model in a large, clinically representative study population proves that routine clinical and pathological variables are not suitable to select patients with large core needle biopsy-proven ductal carcinoma in situ for sentinel node biopsy during primary surgery.

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Section: Discussionmentioning

confidence: 94%

Development and Evaluation of a Prediction Model for Underestimated Invasive Breast Cancer in Women with Ductal Carcinoma In Situ at Stereotactic Large Core Needle Biopsy

et al. 2013

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“…The lesion size in CESM was overestimated by more than 5 mm in the case of 44 (52%) out of the 84 DCISs under analysis. Breast conservation therapy (BCT) surgery with positive margins is reported to occur in 34% of DCIS cases compared to 3–7% in patients with invasive (ductal or lobular) breast cancers [ 28 , 29 ]. In the preoperative treatment planning, obtaining precise information on the extent and distribution of DCIS is important in determining the extent of surgery required.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Comparison of Contrast-Enhanced Spectral Mammography with Digital Mammography in Assessing Tumor Size in 668 Cases of Breast Cancer

et al. 2020

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Background Contrast-enhanced spectral mammography (CESM) is digital mammography with contrast agent. This promising new breast imaging method can be used for planning surgical treatment. This study compared CESM versus digital mammography (MG) in evaluating tumor size in breast cancer. Material/Methods Comparison of tumor dimensions in CESM, MG, and histopathology was made. The correlation of these data was assessed by histopathological type, biological subtype, grading of the carcinoma, and patient age. Results The average difference in tumor size between CESM and histopathological examination was 5 mm. The differences in size measurement between CESM and MG were significant (p=0.00). The Pearson’s linear correlation coefficients of CESM versus HP and MG versus HP were −0.01 (p=0.79) and −0.25 (p=0.00), respectively, indicating no differences between CESM and HP based on the lesion size. A weak negative correlation between those values was observed on MG. No relationship was found between the tumor size in CESM and the biological subtype, carcinoma malignancy degree, or patient age. Conclusions CESM is a new diagnostic method in breast cancer. The accuracy of measurement of tumor size using CESM is independent of lesion size, but it overestimates the size by 5 mm on average. The difference is not dependent on grading, biological subtype of the carcinoma, or patient age. They concern the histopathological type, and values are significantly greater in pre-invasive carcinomas.

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“…Not only is the detection of pathologic calcifications challenging, but also the assessment of disease extent in patients with DCIS or (non-palpable) invasive breast cancer. Breast conservation therapy (BCT) surgery with positive margins is reported to occur in 34% of DCIS cases (7), compared to 3–7% in patients with invasive (ductal or lobular) breast cancers (8). Even the use of contrast-enhanced breast magnetic resonance imaging (MRI), which is generally regarded to be the most accurate imaging modality to assess disease extent (9), does not have any positive impact on the surgical management of DCIS (10).…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management

et al. 2019

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Background Detecting pathological breast calcifications remains challenging. Based on recent studies, contrast-enhanced spectral mammography (CESM) was shown to be superior compared to full-field digital mammography (FFDM). Purpose To evaluate the diagnostic accuracy of CESM in suspicious breast calcifications and its impact on surgical decision-making. Material and Methods All screening recalled patients with suspicious calcifications that underwent CESM in the period October 2012 until September 2015 were included. One experienced radiologist provided a BI-RADS classification for the FFDM images only. The evaluation was repeated for the CESM exam. In a simulated tumor board meeting, two breast surgeons decided on the preferred surgical treatment (breast conservation therapy [BCT] versus mastectomy) for all malignant cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated defining BI-RADS ≥4 as being malignant. In addition, differences in surgical decision-making were analyzed and compared using McNemar’s test. Results In total, 147 women were included in this study (mean age = 61 years; age range = 49–75 years). Pathology showed 82 benign and 65 malignant lesions, of which 33 were ductal carcinomas in situ and 32 were invasive lesions. Diagnostic performances of CESM (differences compared to FFDM in brackets) were: sensitivity 93.8% (+3%), specificity 36.6% (−2.5%), PPV 54% (0%), and NPV 88.2% (+4%). Based on low-energy images, surgeons suggested BCT in 89% of the cases. Based on the CESM exam, no statistical changes in decisions were observed (86% BCT, P = 0.453). Conclusion CESM only slightly improves the diagnostic accuracy of the evaluation of breast calcifications. It is not of added value compared to FFDM in guiding surgical decision-making.

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Surgical Outcome of Patients with Core-Biopsy-Proven Nonpalpable Breast Carcinoma: A Large Cohort Follow-Up Study

Cited by 6 publications

References 36 publications

Development and Evaluation of a Prediction Model for Underestimated Invasive Breast Cancer in Women with Ductal Carcinoma In Situ at Stereotactic Large Core Needle Biopsy

Development and Evaluation of a Prediction Model for Underestimated Invasive Breast Cancer in Women with Ductal Carcinoma In Situ at Stereotactic Large Core Needle Biopsy

Retrospective Comparison of Contrast-Enhanced Spectral Mammography with Digital Mammography in Assessing Tumor Size in 668 Cases of Breast Cancer

Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management

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