Risk factors for invasive breast cancer when core needle biopsy shows ductal carcinoma in situ.
Risk factors for invasive breast cancer when core needle biopsy shows ductal carcinoma in situ.
复制标题
当芯针活检显示原位导管癌时，浸润性乳腺癌的危险因素。
作者：
Emil D. Kurniawan;A. Rose;Arlene Mou;M. Buchanan;J. Collins;M. Wong;Julie A. Miller;G. Mann
假设
导管原位癌（DCIS）的芯针活检（CNB）诊断可能与浸润性癌的最终诊断相关。术前影像学、临床和病理学特征可以识别出高风险的患者，这些患者可能是初次手术时进行前哨淋巴结活检的合适人选。
设计
审查前瞻性收集的数据库。
设置
三级教学转诊医院和一个以人口为基础的乳腺筛查中心。
患者
从1994年1月1日至2006年12月31日，CNB结果显示DCIS或DCIS伴微浸润的连续性患者。
主要观察指标
升级为浸润性癌症。
结果
15例有微浸润的DCIS中11例（73.3%）和375例DCIS中65例（17.3%）升级为浸润癌。21个可触及病灶中有10个（47.6%）发现有微浸润。对于未触及的DCIS，多变量分析显示非钙化性乳腺X线特征（质量、建筑变形或非特定密度）（比值比[95%置信区间]，2.00 [1.02-3.94]），乳房X线摄影尺寸≥ 20 mm（2.80 [1.46-5.38]）和延长3年或更长的筛选间隔（4.41 [1.60-12.13]）与分期上调相关。CNB上的DCIS分级在单变量分析中具有显著性（P = .04）。随着患者中存在显著因素的数量增加，分期上调率增加：无风险因素的患者为8.3%，有1个风险因素的患者为20.8%，有2个风险因素的患者为39.6%，有3个风险因素的患者为57.1%。
结论
可通过CNB上DCIS患者的术前特征估计分期升高的风险。我们提出了一种管理算法，包括前哨淋巴结活检的DCIS患者有微侵犯CNB，可触及DCIS，2个或更多的预测因素，并计划全乳房切除术。
HYPOTHESIS
A core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) may be associated with a final diagnosis of invasive cancer. Preoperative radiologic, clinical, and pathological features may identify patients at high risk of diagnostic upstaging, who may be appropriate candidates for sentinel node biopsy at initial surgery.
DESIGN
Review of prospectively collected database.
SETTING
Tertiary teaching referral hospital and a population-based breast screening center.
PATIENTS
Consecutive patients from January 1, 1994, to December 31, 2006, whose CNB findings showed DCIS or DCIS with microinvasion.
MAIN OUTCOME MEASURES
Upstaging to invasive cancer.
RESULTS
Eleven of 15 cases of DCIS with microinvasion (73.3%) and 65 of 375 cases of DCIS (17.3%) were upstaged to invasive cancer. Ten of 21 palpable lesions (47.6%) were found to have microinvasion. For impalpable DCIS, multivariate analysis showed that noncalcific mammographic features (mass, architectural distortion, or nonspecific density) (odds ratio [95% confidence interval], 2.00 [1.02-3.94]), mammographic size of 20 mm or greater (2.80 [1.46-5.38]), and prolonged screening interval of 3 years or longer (4.41 [1.60-12.13]) were associated with upstaging. The DCIS grade on CNB was significant on univariate analysis (P = .04). The rate of upstaging increased with the number of significant factors present in a patient: 8.3% in patients with no risk factors, 20.8% in those with 1 risk factor, 39.6% in those with 2 risk factors, and 57.1% in those with 3 risk factors.
CONCLUSIONS
The risk of upstaging can be estimated by using preoperative features in patients with DCIS on CNB. We propose a management algorithm that includes sentinel node biopsy for patients with DCIS who have microinvasion on CNB, palpable DCIS, 2 or more predictive factors, and planned total mastectomy.
影响因子：
158.5
作者：
Krag, D;Weaver, D;Beitsch, P
通讯作者：
Beitsch, P