Predictive factors of upstaging DCIS to invasive carcinoma in BCT vs mastectomy

Upstaging from DCIS to invasive ductal carcinoma varies widely from 0 to 59%. We aim to identify risk factors associated with upstaging in all DCIS patients and based on specific surgical intervention. Patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy were reviewed. Multiv...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of surgery 2019-06, Vol.217 (6), p.1025-1029
Main Authors: Sheaffer, W.W., Gray, R.J., Wasif, N., Stucky, C.C., Cronin, P.A., Kosiorek, H.E., Basu, A., Pizzitola, V.J., Patel, B., Giurescu, M.E., Lorans, R., McCullough, A.E., Ocal, I.T., Pockaj, B.A.
Format: Article
Language:English
Subjects:
Adult
Aged
Biopsy
Breast Neoplasms - diagnosis
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Carcinoma, Ductal, Breast - diagnosis
Carcinoma, Ductal, Breast - pathology
Carcinoma, Ductal, Breast - surgery
Carcinoma, Intraductal, Noninfiltrating - diagnosis
Carcinoma, Intraductal, Noninfiltrating - pathology
Carcinoma, Intraductal, Noninfiltrating - surgery
Demographics
Diagnosis
Female
Humans
Invasiveness
Lymph nodes
Lymphatic system
Mammography
Mastectomy
Mastectomy, Radical
Mastectomy, Segmental
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Pathology
Patients
Retrospective Studies
Risk analysis
Risk Factors
Sentinel Lymph Node Biopsy
Studies
Surgeons
Surgery
Tumors
Variables
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Upstaging from DCIS to invasive ductal carcinoma varies widely from 0 to 59%. We aim to identify risk factors associated with upstaging in all DCIS patients and based on specific surgical intervention. Patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy were reviewed. Multivariable analysis was performed to identify risk factors for upstaging. In total, 623 patients had a preoperative diagnosis of DCIS. Upstaging occurred in 74 patients (12%) overall. There was no difference in upstaging rates between mastectomy and BCT (11% v 14% p = 0.27). Sentinel lymph node biopsy was positive in 4/212 patients (1%). Multivariable analysis revealed suspicion of microinvasion (OR 5.7 95%CI2.2–14.9), surgeon suspicion of invasive disease (OR 2.7, 95% CI 1.2–6.4) and larger size/multicentric/extensive tumor (OR 1.9 95% CI 1.1–3.4) increase risk of upstaging. Suspicion of microinvasion, surgeon suspicion, and tumor size can be used to help guide the use of sentinel lymph node biopsy. For patients without these high risk characteristics, it is hard to justify the use of concurrent SLN biopsy for patients who undergo BCT. •Suspicion of microinvasion, surgeon suspicion, and tumor size can guide the use of sentinel lymph node biopsy.•It is hard to justify sentinel lymph node biopsy in BCT patients without these high risk characteristics.•Suspicion of microinvasion is associated with a 50% upstage rate to invasive ductal carcinoma.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2018.12.069