DCIS Diagnosed via Core Needle Biopsy: Upstaging Rate, Microinvasion and Axillary Lymph Node Metastasis
Keywords:ductal carcinoma in situ, microinvasion, upstaging, prediction, axillary lymph node metastasis
AbstractObjective: To determine the upstaging rate of core needle-diagnosed ductal carcinoma in situ (DCIS) to
invasive breast cancer, as well as to identify risk factors for upstaging; and to relate DCIS with or without
microinvasion to the rate of axillary lymph node metastasis.
Methods: Records of breast cancer patients with core needle biopsy (CNB) diagnosis of DCIS with or
without microinvasion who subsequently underwent definitive surgery during the years 2008 to 2010 were
reviewed. Data on clinical findings, mammographic findings, CNB findings, breast surgical procedures, axillary
lymph node procedures, nodal metastasis, and final pathological diagnosis were collected. Upstaging rates were
calculated and compared between DCIS groups and attempts were made to identify risk factors for upstaging
and axillary lymph node metastasis.
Results: CNB-diagnosed pure DCIS were upstaged to any invasive breast cancer in 42% (25/59) of
patients, and to macro-invasive cancer only in 19% (11/59). DCIS with microinvasion was upstaged to macroinvasive
cancer in 34% (10/29). No risk factors were identified which could predict upstaging. Final diagnoses
of pure DCIS, DCIS with microinvasion and macro-invasive breast cancer were associated with axillary lymph
node metastasis rates of 0 (0/33), 5% (1/20) and 24% (5/21), respectively. No set of risk factors could identify
patients with a high likelihood of axillary metastasis.
Conclusion: CNB-diagnosed DCIS with or without microinvasion had a relatively high upstaging rate. No
high-risk group for invasive cancer or axillary lymph node involvement could be identified.
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