Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

Oda,Goshi; Nakagawa,Tsuyoshi; Ogawa,Ayumi; Kumaki,Yuichi; Hosoya,Tokuko; Sugimoto,Hitoshi; Ishiba,Toshiyuki; Mio,Mori; Fujioka,Tomoyuki; Kubota,Kazunori; Onishi,Iichiroh; Uetake,Hiroyuki

doi:10.3892/mco.2020.2036

Predictors for upstaging of ductal carcinoma in situ (DCIS) to invasive carcinoma in non‑mass‑type DCIS

Authors:
- Goshi Oda
- Tsuyoshi Nakagawa
- Ayumi Ogawa
- Yuichi Kumaki
- Tokuko Hosoya
- Hitoshi Sugimoto
- Toshiyuki Ishiba
- Mori Mio
- Tomoyuki Fujioka
- Kazunori Kubota
- Iichiroh Onishi
- Hiroyuki Uetake
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Affiliations: Department of Surgical Specialties, Tokyo Medical and Dental University, Graduate School of Medicine and Dentistry, Bunkyo‑ku, Tokyo 113‑8519, Japan, Department of Radiology, Tokyo Medical and Dental University, Graduate School of Medicine and Dentistry, Bunkyo‑ku, Tokyo 113‑8519, Japan, Department of Pathology, Tokyo Medical and Dental University, Graduate School of Medicine and Dentistry, Bunkyo‑ku, Tokyo 113‑8519, Japan
Published online on: April 27, 2020 https://doi.org/10.3892/mco.2020.2036
Pages: 67-72

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Abstract

Preoperatively diagnosed ductal carcinoma in situ (DCIS) is sometimes upstaged to invasive cancer by postoperative pathological examination. Various preoperative factors associated with upstaging to invasive cancer have been reported; however, this subject remains to be clarified. DCIS takes various forms on imaging, but many cases show non‑mass‑type lesions. In non‑mass‑type DCIS, recognizing the presence of invasion is difficult. To investigate predictors associated with upstaging to invasive cancer more precisely, we examined only non‑mass‑type DCIS. The present study retrospectively analyzed 101 patients diagnosed with non‑mass‑type DCIS preoperatively on breast biopsy at our institution between 2007 and 2017. Data were analyzed using Fisher's exact probability test and two‑sample t‑tests. Multivariate analysis was performed using logistic regression. The results showed that 27 patients (27%) were finally diagnosed with invasive cancer. Univariate analysis revealed abnormal result of palpation on breast examination (P=0.05), comedo necrosis (P=0.05), and HER2 status (P=0.02) as significant predictors. Multivariate analysis revealed an abnormal result of palpation as an independent predictor of invasive cancer underestimation (odds ratio 4.76; conﬁdence interval 1.44‑15.7; P=0.01). In conclusion, preoperatively diagnosed non‑mass‑type DCIS represented an underestimation in approximately 27% of cases. In particular, the presence of a clinically abnormal palpation increases the chance of upstaging to invasive cancer.

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