Prediction of underestimated invasiveness in patients with ductal carcinoma in situ of the breast on percutaneous biopsy as rationale for recommending concurrent sentinel lymph node biopsy |
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| Authors: | Sophie Schulz Peter Sinn Michael Golatta Geraldine Rauch Hans Junkermann Florian Schuetz Christof Sohn Joerg Heil |
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| Affiliation: | 1. Breast Unit, University of Heidelberg Women''s Hospital, Voßstraße 9, 69115 Heidelberg, Germany;2. Department of Pathology, University of Heidelberg, Heidelberg, Germany;3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;1. Division of Gynecological Oncology, Fondazione del Piemonte per l''Oncologia, Turin, Italy;2. Institute for Cancer Research and Treatment (IRCC) of Candiolo, Strada Provinciale 142, Km. 3.95, 10060 Candiolo, Turin, Italy;3. The Clinical Trials Group, Dept. of Surgery, University College of London (UCL), Clerkenwell Bldg, Whittington Campus, London N19 5LW, UK;1. Nuclear Medicine Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;2. Oncology Department, Catalan Institute of Oncology, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;3. Pathology Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;4. Radiology Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;5. Surgery Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;6. Gynecology Department, Germans Trias i Pujol University Hospital, Carretera del Canyet, Badalona, Spain;1. Clinique de Genolier, Switzerland;2. Leiden University Medical Center, The Netherlands;3. Medical School, University of Athens, Athens, Greece;4. Ontario Institute for Cancer Research, Toronto, Canada;5. Weston Park Hospital NHS Trust, Sheffield, United Kingdom;1. Department of Oncology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden;2. Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden;3. Department of Oncology/Pathology, Cancer Centre Karolinska, Karolinska Institutet, Stockholm, Sweden;4. Department of Surgery, Linköping University Hospital, Linköping, Sweden;5. Department of Clinical and Experimental Medicine, Division of Oncology, Faculty of Health Sciences, Linköping University, County Council of Östergötland, Linköping, Sweden;1. Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME ''s-Hertogenbosch, The Netherlands;2. Department of Radiology, Jeroen Bosch Ziekenhuis, ''s-Hertogenbosch, The Netherlands;3. Department of Pathology, Jeroen Bosch Ziekenhuis, ''s-Hertogenbosch, The Netherlands;4. Department of Oncology, Jeroen Bosch Ziekenhuis, ''s-Hertogenbosch, The Netherlands |
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| Abstract: | AimTo develop a model to predict invasion and improve the indication of concurrent sentinel lymph node biopsy (SLNB) for patients with ductal carcinoma in situ (DCIS) on minimally invasive biopsy.MethodsWe evaluated the data of 205 patients with DCIS in minimally invasive biopsy specimens. Clinical, radiological and histological variables were assessed in order to identify predictors of invasive carcinoma in final pathology using logistic regression analyses. We developed and retrospectively tested an algorithm to indicate concurrent SLNB.ResultsInvasiveness was underestimated in 18.0% (37 of 205). Univariate analysis revealed the following significant risk factors: lesion palpability, a mass lesion on ultrasound, the presence of a mammographically detectable mass, architectural distortion or density, a BI-RADS score of 5, a lesion diameter ≥50 mm, and ≥50% of histologically affected ducts. With a palpable mass, which remained the only independent predictor of invasion after multivariate adjustment, and the presence of at least three of the remaining five risk factors, the probability of invasion was 56.0%. If the prediction model had been used to indicate SLNB 9.8% (20 of 205) of patients could have been benefited (i.e. spared unnecessary or correctly recommended concurrent SLNB) compared to the factual performed SLNB procedures. Those patients with pure DCIS treated with breast conserving surgery (BCS) benefited most with a relative risk reduction of nearly 50% for unnecessary SLNB.ConclusionThe prediction model could rationally guide an informed discussion about risks and benefits of concurrent SLNB in patients with DCIS on minimally invasive biopsy. |
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