Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision

Jisun Kim, Wonshik Han, Jong Won Lee, Jee Man You, Hee Chul Shin, Soo Kyung Ahn, Hyeong Gon Moon, Nariya Cho, Wookyung Moon, Inae Park, Dongyoung Noh

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40 Citations (Scopus)

Abstract

Objectives: The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. Materials and methods: We enrolled 506 female CNB-diagnosed DCIS patients who underwent subsequent surgical excision between January 2000 and February 2011. A retrospective analysis of patients undergone core needle biopsy and subsequent surgical excision was performed. Ultrasonography guided CNB was performed using either an 8-, 11-gauge vacuum-assisted method, or a 14-gauge needle automated gun method. Results: The overall upstaging rate was 42.7% (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables). We designed a scoring system to predict lymph node positivity in these patients, and the subsequent ROC curve showed an AUC value of 0.746 (p < 0.001, 95% CI: 0.66-0.82). Patient with a non-high grade lesion that was ≤20 mm in size carried no risk of lymph node positivity. Conclusion: Upstaging was associated with lesions that were large, palpable or high grade. It was also associated with use of the 14-gauge needle method. Our scoring system might be helpful to identify patients who do not require sentinel lymph node biopsy.

Original languageEnglish
Pages (from-to)641-645
Number of pages5
JournalBreast
Volume21
Issue number5
DOIs
StatePublished - Oct 2012

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Large-Core Needle Biopsy
Carcinoma, Intraductal, Noninfiltrating
Needles
Neoplasms
Lymph Nodes
Sentinel Lymph Node Biopsy
Firearms
Vacuum
ROC Curve
Area Under Curve
Ultrasonography
Multivariate Analysis

Keywords

  • Breast cancer
  • Core needle biopsy
  • Ductal carcinoma in situ
  • Underestimation

Cite this

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title = "Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision",
abstract = "Objectives: The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. Materials and methods: We enrolled 506 female CNB-diagnosed DCIS patients who underwent subsequent surgical excision between January 2000 and February 2011. A retrospective analysis of patients undergone core needle biopsy and subsequent surgical excision was performed. Ultrasonography guided CNB was performed using either an 8-, 11-gauge vacuum-assisted method, or a 14-gauge needle automated gun method. Results: The overall upstaging rate was 42.7{\%} (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables). We designed a scoring system to predict lymph node positivity in these patients, and the subsequent ROC curve showed an AUC value of 0.746 (p < 0.001, 95{\%} CI: 0.66-0.82). Patient with a non-high grade lesion that was ≤20 mm in size carried no risk of lymph node positivity. Conclusion: Upstaging was associated with lesions that were large, palpable or high grade. It was also associated with use of the 14-gauge needle method. Our scoring system might be helpful to identify patients who do not require sentinel lymph node biopsy.",
keywords = "Breast cancer, Core needle biopsy, Ductal carcinoma in situ, Underestimation",
author = "Jisun Kim and Wonshik Han and Lee, {Jong Won} and You, {Jee Man} and Shin, {Hee Chul} and Ahn, {Soo Kyung} and Moon, {Hyeong Gon} and Nariya Cho and Wookyung Moon and Inae Park and Dongyoung Noh",
year = "2012",
month = "10",
doi = "10.1016/j.breast.2012.06.012",
language = "English",
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pages = "641--645",
journal = "Breast",
issn = "0960-9776",
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T1 - Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision

AU - Kim, Jisun

AU - Han, Wonshik

AU - Lee, Jong Won

AU - You, Jee Man

AU - Shin, Hee Chul

AU - Ahn, Soo Kyung

AU - Moon, Hyeong Gon

AU - Cho, Nariya

AU - Moon, Wookyung

AU - Park, Inae

AU - Noh, Dongyoung

PY - 2012/10

Y1 - 2012/10

N2 - Objectives: The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. Materials and methods: We enrolled 506 female CNB-diagnosed DCIS patients who underwent subsequent surgical excision between January 2000 and February 2011. A retrospective analysis of patients undergone core needle biopsy and subsequent surgical excision was performed. Ultrasonography guided CNB was performed using either an 8-, 11-gauge vacuum-assisted method, or a 14-gauge needle automated gun method. Results: The overall upstaging rate was 42.7% (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables). We designed a scoring system to predict lymph node positivity in these patients, and the subsequent ROC curve showed an AUC value of 0.746 (p < 0.001, 95% CI: 0.66-0.82). Patient with a non-high grade lesion that was ≤20 mm in size carried no risk of lymph node positivity. Conclusion: Upstaging was associated with lesions that were large, palpable or high grade. It was also associated with use of the 14-gauge needle method. Our scoring system might be helpful to identify patients who do not require sentinel lymph node biopsy.

AB - Objectives: The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy (CNB)-diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. Materials and methods: We enrolled 506 female CNB-diagnosed DCIS patients who underwent subsequent surgical excision between January 2000 and February 2011. A retrospective analysis of patients undergone core needle biopsy and subsequent surgical excision was performed. Ultrasonography guided CNB was performed using either an 8-, 11-gauge vacuum-assisted method, or a 14-gauge needle automated gun method. Results: The overall upstaging rate was 42.7% (216/506). Multivariate analysis found that a palpable lesion, a lesion size >20 mm, a high grade lesion, and use of the 14-gauge needle method were independently associated with upstaging (p < 0.05 for all variables). We designed a scoring system to predict lymph node positivity in these patients, and the subsequent ROC curve showed an AUC value of 0.746 (p < 0.001, 95% CI: 0.66-0.82). Patient with a non-high grade lesion that was ≤20 mm in size carried no risk of lymph node positivity. Conclusion: Upstaging was associated with lesions that were large, palpable or high grade. It was also associated with use of the 14-gauge needle method. Our scoring system might be helpful to identify patients who do not require sentinel lymph node biopsy.

KW - Breast cancer

KW - Core needle biopsy

KW - Ductal carcinoma in situ

KW - Underestimation

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