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  • Title: Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision.
    Author: Kim J, Han W, Lee JW, You JM, Shin HC, Ahn SK, Moon HG, Cho N, Moon WK, Park IA, Noh DY.
    Journal: Breast; 2012 Oct; 21(5):641-5. PubMed ID: 22749854.
    Abstract:
    OBJECTIVES: The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. MATERIALS AND METHODS: We enrolled 506 female CNB-diagnosed DCIS patients who underwent subsequent surgical excision between January 2000 and February 2011. A retrospective analysis of patients undergone core needle biopsy and subsequent surgical excision was performed. Ultrasonography guided CNB was performed using either an 8-, 11-gauge vacuum-assisted method, or a 14-gauge needle automated gun method. RESULTS: The overall upstaging rate was 42.7% (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables). We designed a scoring system to predict lymph node positivity in these patients, and the subsequent ROC curve showed an AUC value of 0.746 (p < 0.001, 95% CI: 0.66-0.82). Patient with a non-high grade lesion that was ≤20 mm in size carried no risk of lymph node positivity. CONCLUSION: Upstaging was associated with lesions that were large, palpable or high grade. It was also associated with use of the 14-gauge needle method. Our scoring system might be helpful to identify patients who do not require sentinel lymph node biopsy.
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