Predictors of invasive disease in patients preoperatively diagnosed with ductal carcinoma without stromal invasion, with
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ORIGINAL ARTICLE
Predictors of invasive disease in patients preoperatively diagnosed with ductal carcinoma without stromal invasion, with breast magnetic resonance imaging (MRI) and ultrasound (US) Hinako Maeda1 · Tetsu Hayashida1 · Rurina Watanuki1 · Masayuki Kikuchi1 · Ayako Nakashoji1 · Takamichi Yokoe1 · Tomoko Seki1 · Maiko Takahashi1 · Yuko Kitagawa1 Received: 21 April 2020 / Accepted: 6 October 2020 © The Japanese Breast Cancer Society 2020
Abstract Background A preoperative diagnosis of ductal carcinoma in situ (DCIS) is sometimes upstaged to invasive disease postoperatively. Our objective was to clarify the predictive factors of invasive disease using preoperative imaging and to investigate the positive ratio of sentinel lymph nodes (SLN) and the incidence of invasive disease. Methods The subjects were 402 patients with preoperatively diagnosed ductal carcinoma without stromal invasion who underwent breast surgery with concomitant SLN surgery in January 2007 to December 2016. Of the 306 included patients, all 306 patients underwent preoperative MRI and US assessment. Outcomes were analyzed for significance using univariate and multivariate analyses. Results Of the 306 patients, 115 (37.6%) had invasive disease and 191 (62.4%) had DCIS only. Of the 115 patients with invasive disease, 5 (4.4%) and 4 (3.5%) had macro- and micrometastases in SLN. On the other hand, of the 191 patients with DCIS, only 1 (0.5%) had a micrometastasis. Predictors of invasive disease in the univariate analysis included having a palpable mass, were varied by biopsy method, having a US hypoechoic mass, MRI enhancement, or MRI large enhanced lesion; the size of the mass enhancement ≥ 1.1 cm or a spread of non-mass enhancement ≥ 3.1 cm (P = 0.003). Predictors of invasive disease in the multivariate analysis included US hypoechoic mass and MRI large enhanced lesion. Conclusion We need to perform SLN biopsy for preoperatively diagnosed DCIS when patients have predictors of invasive disease, but SLN biopsy will no longer be essential for patients when they have no predictors of invasive disease. Keywords DCIS · Predictive factors · MRI · US · SLN biopsy
Introduction Ductal carcinoma in situ (DCIS) accounts for 20–25% of newly diagnosed breast cancer cases annually [1]. By definition, DCIS is a non-invasive lesion with malignant cells bound by the basement membrane [2]; therefore, sentinel lymph node (SLN) surgery is typically not advised. However, lesions initially diagnosed as DCIS on needle biopsy are occasionally upstaged to invasive cancer after * Tetsu Hayashida [email protected] Hinako Maeda [email protected] 1
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo 160‑8582, Japan
the final pathology report of the completely excised specimen. This is due to the inherent limitations of biopsy sampling techniques, by which a small invasive lesion may fail to be detected in a large area of intraductal lesions. Today, this upstaging occurs in 8–38% of patients with a needlebio
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