Noncalcified Ductal Carcinoma In Situ (DCIS): Rate and Predictors of Upgrade to Invasive Carcinoma
Noncalcified Ductal Carcinoma In Situ (DCIS): Rate and Predictors of Upgrade to Invasive Carcinoma
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DOI：
10.1016/j.acra.2020.02.011
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发表时间：
2021-02-15
影响因子：
4.8
通讯作者：
Bahl, Manisha
中科院分区：
文献类型：
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作者：
Lamb, Leslie R.;Kim, Geunwon;Bahl, Manisha
来自马萨诸塞州总医院/放射科，55 Fruit Street, WAC 240, Boston, MA 02114（L.R.L.、G.K.、M.B.）；马萨诸塞州总医院/外科，波士顿，马萨诸塞州 (T.O.O.)。 2020年1月27日收到； 2020年2月11日修订； 2020 年 2 月 14 日接受。地址理由和目标：确定非钙化导管原位癌 (DCIS) 的升级率以及与手术时升级为侵袭性疾病风险相关的特征。材料和方法：对 2007 年 1 月至 2016 年 12 月期间被诊断为非钙化 DCIS 的连续女性进行回顾性分析。对患者人口统计学、影像学结果、活检病理结果和手术结果进行了回顾。使用非配对 t 检验、卡方检验和 Fisher 精确检验来比较手术时升级为浸润性癌和未升级为浸润性癌的 DCIS 病例之间的特征。结果：在 10 年期间，78 名女性（平均年龄 62 岁，范围 30-88 岁）被诊断患有非钙化 DCIS。三分之二（67.9%，53/78）的病例是通过筛查性乳房X光检查发现的，15.4%（12/78）的诊断是在出现明显关注区域后做出的。非钙化 DCIS 最常见的乳房 X 线检查表现为肿块 (51.3%, 40/78) 和不对称 (30.8%, 24/78)。 17 例（21.8%，17/78）在手术中升级为浸润性导管癌（IDC）。与升级风险相关的特征包括患者年龄较大（68.1 岁与 60.3 岁，OR 1.08，p < 0.01）和一级亲属乳腺癌家族史（41.2% [7/17] 与 16.4% [10/61]，OR 3.57，p = 0.03）。结论：在我们的研究队列中，手术时非钙化 DCIS 升级为 IDC 的率为 21.8%。升级风险与患者年龄较大和一级亲属的乳腺癌家族史有关。
From the Massachusetts General Hospital/Department of Radiology, 55 Fruit Street, WAC 240, Boston, MA 02114 (L.R.L., G.K., M.B.); Massachusetts General Hospital/Department of Surgery, Boston, MA (T.O.O.). Received January 27, 2020; revised February 11, 2020; accepted February 14, 2020. AddressRationale and Objectives: To determine the upgrade rate of noncalcified ductal carcinoma in situ (DCIS) and features that are associated with risk of upgrade to invasive disease at surgery. Materials and Methods: A retrospective review was conducted of consecutive women who were diagnosed with noncalcified DCIS from January 2007 to December 2016. Patient demographics, imaging findings, biopsy pathology results, and surgical outcomes were reviewed. The unpaired t test, chi-square test, and Fisher?s exact test were used to compare features between the cases of DCIS that did and did not upgrade to invasive carcinoma at surgery. Results: Over a 10-year period, 78 women (mean age 62 years, range 30-88 years) were diagnosed with noncalcified DCIS. Two-thirds (67.9%, 53/78) of cases were detected on screening mammography, and 15.4% (12/78) of diagnoses were made after presentation with an area of palpable concern. The most common mammographic presentations of noncalcified DCIS were mass (51.3%, 40/78) and asymmetry (30.8%, 24/78). Seventeen cases (21.8%, 17/78) were upgraded to invasive ductal carcinoma (IDC) at surgery. Features associated with upgrade risk included older patient age (68.1 versus 60.3 years, OR 1.08, p < 0.01) and family history of breast cancer in a first-degree relative (41.2% [7/17] versus 16.4% [10/61], OR 3.57, p = 0.03). Conclusion: In our study cohort, the upgrade rate of noncalcified DCIS to IDC at surgery is 21.8%. Upgrade risk is associated with older patient age and family history of breast cancer in a first-degree relative.