DCIS Diagnosed via Core Needle Biopsy: Upstaging Rate, Microinvasion and Axillary Lymph Node Metastasis

Sukarayothin, Thongchai; Luadthai, Praweena; Chirappapha, Prakasit; Wasuthit, Yodying; Suvikapakornkul, Ronnarat; Kongdan, Youwanush; Lertsithichai, Panuwat
July 2012
Thai Journal of Surgery;Jul-Sep2012, Vol. 33 Issue 3, p61
Academic Journal
Objective: 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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