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Wu H, Jiang Y, Tian H, Ye X, Cui C, Shi S, Chen M, Ding Z, Li S, Huang Z, Luo Y, Peng Q, Xu J, Dong F. Sonography-based multimodal information platform for identifying the surgical pathology of ductal carcinoma in situ. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108039. [PMID: 38266556 DOI: 10.1016/j.cmpb.2024.108039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The risk of ductal carcinoma in situ (DCIS) identified by biopsy often increases during surgery. Therefore, confirming the DCIS grade preoperatively is necessary for clinical decision-making. PURPOSE To train a three-classification deep learning (DL) model based on ultrasound (US), combining clinical data, mammography (MG), US, and core needle biopsy (CNB) pathology to predict low-grade DCIS, intermediate-to-high-grade DCIS, and upstaged DCIS. MATERIALS AND METHODS Data of 733 patients with 754 DCIS cases confirmed by biopsy were retrospectively collected from May 2013 to June 2022 (N1), and other data (N2) were confirmed by biopsy as low-grade DCIS. The lesions were randomly divided into training (n=471), validation (n=142), and test (n = 141) sets to establish the DCIS-Net. Information on the DCIS-Net, clinical (age and sign), US (size, calcifications, type, breast imaging reporting and data system [BI-RADS]), MG (microcalcifications, BI-RADS), and CNB pathology (nuclear grade, architectural features, and immunohistochemistry) were collected. Logistic regression and random forest analyses were conducted to develop Multimodal DCIS-Net to calculate the specificity, sensitivity, accuracy, receiver operating characteristic curve, and area under the curve (AUC). RESULTS In the test set of N1, the accuracy and AUC of the multimodal DCIS-Net were 0.752-0.766 and 0.859-0.907 in the three-classification task, respectively. The accuracy and AUC for discriminating DCIS from upstaged DCIS were 0.751-0.780 and 0.829-0.861, respectively. In the test set of N2, the accuracy and AUC of discriminating low-grade DCIS from upstaged low-grade DCIS were 0.769-0.987 and 0.818-0.939, respectively. DL was ranked from one to five in the importance of features in the multimodal-DCIS-Net. CONCLUSION By developing the DCIS-Net and integrating it with multimodal information, diagnosing low-grade DCIS, intermediate-to high-grade DCIS, and upstaged DCIS is possible. It can also be used to distinguish DCIS from upstaged DCIS and low-grade DCIS from upstaged low-grade DCIS, which could pave the way for the DCIS clinical workflow.
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Affiliation(s)
- Huaiyu Wu
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Yitao Jiang
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China; Research and Development Department, Microport Prophecy, Shanghai 201203, China
| | - Hongtian Tian
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Xiuqin Ye
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Chen Cui
- Research and Development Department, Illuminate, LLC, Shenzhen, Guangdong 518000, China
| | - Siyuan Shi
- Research and Development Department, Illuminate, LLC, Shenzhen, Guangdong 518000, China
| | - Ming Chen
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Zhimin Ding
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Shiyu Li
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Zhibin Huang
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Yuwei Luo
- Department of Breast Surgery, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China; Department of General Surgery, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China
| | - Quanzhou Peng
- Department of Pathology, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China.
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Paul K, Razmi S, Pockaj BA, Ladani L, Stromer J. Finite Element Modeling of Quantitative Ultrasound Analysis of the Surgical Margin of Breast Tumor. Tomography 2022; 8:570-584. [PMID: 35314624 PMCID: PMC8938815 DOI: 10.3390/tomography8020047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Ultrasound is commonly used as an imaging tool in the medical sector. Compared to standard ultrasound imaging, quantitative ultrasound analysis can provide more details about a material microstructure. In this study, quantitative ultrasound analysis was conducted through computational modeling to detect various breast duct pathologies in the surgical margin tissue. Both pulse-echo and pitch-catch methods were evaluated for a high-frequency (22–41 MHz) ultrasound analysis. The computational surgical margin modeling was based on various conditions of breast ducts, such as normal duct, ductal hyperplasia, DCIS, and calcification. In each model, ultrasound pressure magnitude variation in the frequency spectrum was analyzed through peak density and mean-peak-to-valley distance (MPVD) values. Furthermore, the spectral patterns of all the margin models were compared to extract more pathology-based information. For the pitch-catch mode, only peak density provided a trend in relation to different duct pathologies. For the pulse-echo mode, only the MPVD was able to do that. From the spectral comparison, it was found that overall pressure magnitude, spectral variation, peak pressure magnitude, and corresponding frequency level provided helpful information to differentiate various pathologies in the surgical margin.
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Affiliation(s)
- Koushik Paul
- School for Engineering of Matter, Transport and Energy, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ 85281, USA;
- Correspondence:
| | - Samuel Razmi
- EnMed Department, Texas A&M College of Medicine, Houston, TX 77807, USA;
| | | | - Leila Ladani
- School for Engineering of Matter, Transport and Energy, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ 85281, USA;
| | - Jeremy Stromer
- Survivability Engineering Branch, US Army Engineer Research and Development Center, Vicksburg, MS 39180, USA;
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Lee SE, Kim GR, Han K, Kim EH, Kim EK, Kim MJ, Yoon JH, Park VY, Moon HJ. US, Mammography, and Histopathologic Evaluation to Identify Low Nuclear Grade Ductal Carcinoma in Situ. Radiology 2022; 303:276-284. [PMID: 35166586 DOI: 10.1148/radiol.211425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Low nuclear grade ductal carcinoma in situ (DCIS) identified at biopsy can be upgraded to intermediate to high nuclear grade DCIS at surgery. Methods that confirm low nuclear grade are needed to consider nonsurgical approaches for these patients. Purpose To develop a preoperative model to identify low nuclear grade DCIS and to evaluate factors associated with low nuclear grade DCIS at biopsy that was not upgraded to intermediate to high nuclear grade DCIS at surgery. Materials and Methods In this retrospective study, 470 women (median age, 50 years; interquartile range, 44-58 years) with 477 pure DCIS lesions at surgical histopathologic evaluation were included (January 2010 to December 2015). Patients were divided into the training set (n = 330) or validation set (n = 147) to develop a preoperative model to identify low nuclear grade DCIS. Features at US (mass, nonmass) and at mammography (morphologic characteristics, distribution of microcalcification) were reviewed. The upgrade rate of low nuclear grade DCIS was calculated, and multivariable regression was used to evaluate factors for associations with low nuclear grade DCIS that was not upgraded later. Results A preoperative model that included lesions manifesting as a mass at US without microcalcification and no comedonecrosis at biopsy was used to identify low nuclear grade DCIS, with a high area under the receiver operating characteristic curve of 0.97 (95% CI: 0.94, 1.00) in the validation set. The upgrade rate of low nuclear grade DCIS at biopsy was 38.8% (50 of 129). Ki-67 positivity (odds ratio, 0.04; 95% CI: 0.0003, 0.43; P = .005) was inversely associated with constant low nuclear grade DCIS. Conclusion The upgrade rate of low nuclear grade ductal carcinoma in situ (DCIS) at biopsy to intermediate to high nuclear grade DCIS at surgery occurred in more than a third of patients; low nuclear grade DCIS at final histopathologic evaluation could be identified if the mass was viewed at US without microcalcifications and had no comedonecrosis at histopathologic evaluation of biopsy. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Rahbar in this issue.
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Affiliation(s)
- Si Eun Lee
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Ga Ram Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Kyunghwa Han
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Eun Hwa Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Eun-Kyung Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Min Jung Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Jung Hyun Yoon
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Vivian Youngjean Park
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Hee Jung Moon
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
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Si J, Guo R, Huang N, Xiu B, Zhang Q, Chi W, Wu J. Axillary evaluation is not warranted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy. Cancer Med 2019; 8:7586-7593. [PMID: 31660702 PMCID: PMC6912045 DOI: 10.1002/cam4.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/14/2019] [Accepted: 09/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Patients diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) have a great chance of upstaging to invasive cancer. Positive axillary status can be found in these patients. This study sought to identify clinicopathological factors associated with upstaging and axillary metastasis in patients preoperatively diagnosed with DCIS by CNB. Materials and Methods This study identified 604 patients (cT1‐3N0M0) with preoperative diagnosis of pure DCIS by CNB who had undergone axillary evaluation from August 2006 to December 2015 at Fudan University Shanghai Cancer Center (FUSCC). Predictors of upstaging and axillary lymph nodes metastasis were analyzed, respectively. Results Of all 604 patients, 121 (20.03%) and 193 (31.95%) patients were upstaged to DCIS with microinvasion (DCISM) and invasive breast cancer (IBC). Positive axillary lymph nodes were identified in 41 (6.79%) patients. Predictors of upstaging included tumor size on ultrasonography (>2 cm) (OR 1.786, P = .002) and ER+HER2+ status (OR 1.874, P = .022) in multivariate analysis. Factors associated with axillary lymph nodes metastasis included tumor size on pathology (OR 2.336, P = .038) and number of lesions (OR 3.354, P = .039) in multivariate analysis. In addition, upstaging on final pathology had a significant influence on axillary lymph nodes status (P < .001). Conclusion Axillary evaluation was recommended in patients with larger tumor size (>2 cm), multifocal lesions or ER+HER2+ status. Despite of a 51.98% upstaging rate, the rate of axillary metastasis in these patients was relatively low, supporting the omission of axillary evaluation in selected patients with low risk of upstaging or axillary metastasis.
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Affiliation(s)
- Jing Si
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Naisi Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qi Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Weiru Chi
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
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Bazzocchi M, Vianello E, Linda A, Londero V, Zuiani C. Male Breast Lesions: Which Abnormalities Really Need Core Needle Biopsy? TUMORI JOURNAL 2018; 96:266-70. [DOI: 10.1177/030089161009600213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The purpose of the study was to identify clinical, mammographic or sonographic abnormalities of the male breast that require histological characterization. Methods and study design Clinical and imaging features of 31 male patients with breast lesions were retrospectively evaluated and correlated with core needle biopsy results. Results Seven of 31 (22.6%) lesions proved to be malignant and 24 of 31 (77.4%) benign, with a benign/malignant ratio of 4.4:1. In the case of a suspicious clinical presentation (firm mass, nipple retraction) and/or the presence of risk factors for breast cancer (BRCA2 mutation, previous breast cancer), core needle biopsy always demonstrated malignancy. All malignant lesions identified on mammography (4 of 7) appeared as a mass. Benign lesions detected on mammography (21 of 24) presented as an area of increased density (20 of 21) more frequently than a mass (1 of 21). Conclusions Sonographic features of cancers were not different from those of benign lesions. Clinical and mammographic findings, along with patient history, can be useful in the identification of male breast lesions that require core needle biopsy.
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Affiliation(s)
- Massimo Bazzocchi
- Istituto di Radiologia, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Elena Vianello
- Istituto di Radiologia, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Anna Linda
- Istituto di Radiologia, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Viviana Londero
- Istituto di Radiologia, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Chiara Zuiani
- Istituto di Radiologia, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
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Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ. Eur Radiol 2016; 27:7-15. [PMID: 27085697 DOI: 10.1007/s00330-016-4359-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate whether mass stiffness measured by shear-wave elastography (SWE) can predict the histological upgrade of ductal carcinoma in situ (DCIS) confirmed through ultrasound (US)-guided core needle biopsy (CNB). METHODS The institutional review board approved this study and informed consent was waived. A database search revealed 120 biopsy-confirmed DCIS in patients who underwent B-mode US and SWE prior to surgery. Clinicopathologic results, B-mode findings, size on US, and mean and maximum elasticity values on SWE were recorded. Associations between upgrade to invasive cancer and B-mode US findings, SWE information, and clinical variables were assessed using univariate, multivariate logistic regression, and multiple linear regression analysis. RESULTS The overall upgrade rate was 41.7 % (50/120). Mean stiffness value (P = .014) and mass size (P = .001) were significantly correlated with histological upgrade. The optimal cut-off value of mean stiffness value, yielding the maximal sum of sensitivity and specificity, was 70.7 kPa showing sensitivity of 72 % and specificity of 65.7 % for detecting invasiveness. Qualitative elasticity colour scores were significantly correlated with the histological upgrade, mammographic density, and B-mode category (P < .04). CONCLUSION Mean stiffness values evaluated through SWE can be utilized as a preoperative predictor of histological upgrade to invasive cancer in DCIS confirmed at US-guided needle biopsy. KEY POINTS • Higher stiffness values were noted in invasive cancer than DCIS. • Qualitative SWE colour scores significantly correlated with the histological upgrade. • Qualitative SWE colour scores had excellent interobserver agreement.
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Mathenge EG, Dean CA, Clements D, Vaghar-Kashani A, Photopoulos S, Coyle KM, Giacomantonio M, Malueth B, Nunokawa A, Jordan J, Lewis JD, Gujar SA, Marcato P, Lee PW, Giacomantonio CA. Core needle biopsy of breast cancer tumors increases distant metastases in a mouse model. Neoplasia 2014; 16:950-60. [PMID: 25425969 PMCID: PMC4240917 DOI: 10.1016/j.neo.2014.09.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION: Incisional biopsies, including the diagnostic core needle biopsy (CNB), routinely performed before surgical excision of breast cancer tumors are hypothesized to increase the risk of metastatic disease. In this study, we experimentally determined whether CNB of breast cancer tumors results in increased distant metastases and examine important resultant changes in the primary tumor and tumor microenvironment associated with this outcome. METHOD: To evaluate the effect of CNB on metastasis development, we implanted murine mammary 4T1 tumor cells in BALB/c mice and performed CNB on palpable tumors in half the mice. Subsequently, emulating the human scenario, all mice underwent complete tumor excision and were allowed to recover, with attendant metastasis development. Tumor growth, lung metastasis, circulating tumor cell (CTC) levels, variation in gene expression, composition of the tumor microenvironment, and changes in immunologic markers were compared in biopsied and non-biopsied mice. RESULTS: Mice with biopsied tumors developed significantly more lung metastases compared to non-biopsied mice. Tumors from biopsied mice contained a higher frequency of myeloid-derived suppressor cells (MDSCs) accompanied by reduced CD4 + T cells, CD8 + T cells, and macrophages, suggesting biopsy-mediated development of an increasingly immunosuppressive tumor microenvironment. We also observed a CNB-dependent up-regulation in the expression of SOX4, Ezh2, and other key epithelial-mesenchymal transition (EMT) genes, as well as increased CTC levels among the biopsy group. CONCLUSION: CNB creates an immunosuppressive tumor microenvironment, increases EMT, and facilitates release of CTCs, all of which likely contribute to the observed increase in development of distant metastases.
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MESH Headings
- Animals
- Biopsy, Large-Core Needle
- Breast/metabolism
- Breast/pathology
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Cell Line, Tumor
- Cytokines/genetics
- Disease Models, Animal
- Enhancer of Zeste Homolog 2 Protein
- Epithelial-Mesenchymal Transition/genetics
- Female
- Flow Cytometry
- Gene Expression Regulation, Neoplastic
- Humans
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Lung Neoplasms/secondary
- Lymphocytes/metabolism
- Macrophages/metabolism
- Mammary Glands, Animal/metabolism
- Mammary Glands, Animal/pathology
- Mammary Neoplasms, Experimental/genetics
- Mammary Neoplasms, Experimental/metabolism
- Mammary Neoplasms, Experimental/pathology
- Mice, Inbred BALB C
- Neoplastic Cells, Circulating/metabolism
- Polycomb Repressive Complex 2/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- SOXC Transcription Factors/genetics
- Tumor Microenvironment/genetics
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Affiliation(s)
- Edward Gitau Mathenge
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl Ann Dean
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Derek Clements
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmad Vaghar-Kashani
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steffany Photopoulos
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Krysta Mila Coyle
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Giacomantonio
- Department of Biology, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Benjamin Malueth
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Nunokawa
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Jordan
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John D. Lewis
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Shashi Ashok Gujar
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Strategy and Organizational Performance, IWK Health Center, Halifax, Nova Scotia, Canada
| | - Paola Marcato
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick W.K. Lee
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carman Anthony Giacomantonio
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Address all correspondence to: Carman Anthony Giacomantonio, MD, MSc, Departments of Surgery and Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada.
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Microbiopsie mammaire : fiabilité en fonction du BIRADS. IMAGERIE DE LA FEMME 2014. [DOI: 10.1016/j.femme.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Diepstraten SCE, van de Ven SMWY, Pijnappel RM, Peeters PHM, van den Bosch MAAJ, Verkooijen HM, Elias SG. Development and evaluation of a prediction model for underestimated invasive breast cancer in women with ductal carcinoma in situ at stereotactic large core needle biopsy. PLoS One 2013; 8:e77826. [PMID: 24147085 PMCID: PMC3795649 DOI: 10.1371/journal.pone.0077826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/11/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to develop a multivariable model for prediction of underestimated invasiveness in women with ductal carcinoma in situ at stereotactic large core needle biopsy, that can be used to select patients for sentinel node biopsy at primary surgery. METHODS From the literature, we selected potential preoperative predictors of underestimated invasive breast cancer. Data of patients with nonpalpable breast lesions who were diagnosed with ductal carcinoma in situ at stereotactic large core needle biopsy, drawn from the prospective COBRA (Core Biopsy after RAdiological localization) and COBRA2000 cohort studies, were used to fit the multivariable model and assess its overall performance, discrimination, and calibration. RESULTS 348 women with large core needle biopsy-proven ductal carcinoma in situ were available for analysis. In 100 (28.7%) patients invasive carcinoma was found at subsequent surgery. Nine predictors were included in the model. In the multivariable analysis, the predictors with the strongest association were lesion size (OR 1.12 per cm, 95% CI 0.98-1.28), number of cores retrieved at biopsy (OR per core 0.87, 95% CI 0.75-1.01), presence of lobular cancerization (OR 5.29, 95% CI 1.25-26.77), and microinvasion (OR 3.75, 95% CI 1.42-9.87). The overall performance of the multivariable model was poor with an explained variation of 9% (Nagelkerke's R(2)), mediocre discrimination with area under the receiver operating characteristic curve of 0.66 (95% confidence interval 0.58-0.73), and fairly good calibration. CONCLUSION The evaluation of our multivariable prediction model in a large, clinically representative study population proves that routine clinical and pathological variables are not suitable to select patients with large core needle biopsy-proven ductal carcinoma in situ for sentinel node biopsy during primary surgery.
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Affiliation(s)
| | | | - Ruud M. Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Helena M. Verkooijen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Fusco R, Petrillo A, Catalano O, Sansone M, Granata V, Filice S, D'Aiuto M, Pankhurst Q, Douek M. Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer 2012; 21:522-31. [PMID: 23115016 DOI: 10.1007/s12282-012-0427-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Abstract
Accurate location of small breast lesions is mandatory for proper surgical management. The purpose of this article is systematically review procedures used to locate non-palpable breast lesions, including a description of the current status, advantages, and disadvantages for each technique. A total of 47 articles were finally included: 7 articles for the wire location technique, 5 articles for the radioguided location technique, 13 articles that compare wire location with radioguided location, 3 articles for the carbon location technique, 2 articles that compare wire location with carbon location, and 17 articles for the clip location technique. The success of location and the clear margin are reported for each location technique and for the separate articles included; clip migration shift, also, is reported for the clip location technique. Odds ratio with related 95 % confidence intervals were also calculated for successful location. Comparative analysis or meta-analysis for all the different breast lesion location techniques is missing. Prospective investigations and randomized investigations for homogeneous populations are still needed to determine which is the most cost-effective modality among those used to date.
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Affiliation(s)
- Roberta Fusco
- Department of Diagnostic Unit, National Cancer Institute, Pascale Foundation, via M. Semmola, 80131, Naples, Italy
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Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision. Breast 2012; 21:641-5. [DOI: 10.1016/j.breast.2012.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/09/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
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Suh YJ, Kim MJ, Kim EK, Moon HJ, Kwak JY, Koo HR, Yoon JH. Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy. Br J Radiol 2012; 85:e349-56. [PMID: 22422382 DOI: 10.1259/bjr/30974918] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the underestimation rate of invasive carcinoma in cases with ductal carcinoma in situ (DCIS) at percutaneous ultrasound-guided core biopsies of breast lesions between 14-gauge automated core-needle biopsy (ACNB) and 8- or 11-gauge vacuum-assisted biopsy (VAB), and to determine the relationship between the lesion type (mass or microcalcification on radiological findings) and the DCIS underestimation rate. METHODS We retrospectively reviewed imaging-guided biopsies of breast lesions performed from February 2003 to August 2008. 194 lesions were diagnosed as DCIS at ultrasound-guided core biopsy: 138 lesions in 132 patients by 14-gauge ACNB, and 56 lesions in 56 patients by 8- or 11-gauge VAB. The histological results of the core biopsy samples were correlated with surgical specimens. The clinical and radiological findings were also reviewed. The histological DCIS underestimation rates were compared between the two groups and were analysed for differences according to the clinical and radiological characteristics of the lesions. RESULTS The DCIS underestimation rate was 47.8% (66/138) for 14-gauge ACNB and 16.1% (9/56) for VAB (p<0.001). According to the lesion type on sonography, DCIS underestimation was 43.4% (63/145) in masses (47.6% using ACNB and 15.8% using VAB; p=0.012) and 24.5% (12/49) in microcalcifications (50.0% using ACNB and 16.2% using VAB; p=0.047). CONCLUSION The underestimation rate of invasive carcinoma in cases with DCIS at ultrasound-guided core biopsies was significantly higher for ACNB than for VAB. Furthermore, this difference does not change according to the lesion type on ultrasound. Therefore, ultrasound-guided VAB can be a useful method for the diagnosis of DCIS lesions presented as either mass or microcalcification.
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Affiliation(s)
- Y J Suh
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
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MRI Findings of Pure Ductal Carcinoma in Situ: Kinetic Characteristics Compared According to Lesion Type and Histopathologic Factors. AJR Am J Roentgenol 2011; 196:1450-6. [DOI: 10.2214/ajr.10.5027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Gwak YJ, Kim HJ, Kwak JY, Lee SK, Shin KM, Lee HJ, Kim GC, Jang YJ, Han MH, Park JY, Jung JH. Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol 2011; 52:364-71. [PMID: 21498298 DOI: 10.1258/ar.2011.100391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Most ductal carcinoma in situ (DCIS) of the breast is asymptomatic and usually manifests as calcifications in screening mammography. On the other hand, little is known about ultrasonographic (US) features of asymptomatic DCIS, for US is rarely used for the diagnosis and evaluation of DCIS because of low sensitivity in detecting microcalcifications. PURPOSE To evaluate US detection and characterization of DCIS in asymptomatic women and correlate these imaging findings with the histopathologic features. MATERIAL AND METHODS This retrospective study evaluated mammographic and US images of 60 DCIS cases from 59 asymptomatic women. US was performed in knowledge of mammographic findings. The following histopathologic parameters were analyzed: Van Nuys classification, architectural pattern, and presence of microinvasion. Image detectability and US features were correlated with these histopathologic parameters. RESULTS Of the 54 cases (90.0%) detected on mammography, 48 cases (88.9%) had microcalcifications only, 5 (9.3%) had microcalcifications with associated density, and 1 (1.9%) had soft tissue density alone. Of the 38 cases (63.3%) identified by US, 29 cases (76.3%) had a mass with or without microcalcifications, six (15.8%) had microcalcifications only, and three (7.9%) had other findings. US identified lesions were associated with higher Van Nuys groups, microinvasion and comedocarcinoma (P = 0.044, P = 0.024, and P = 0.032, respectively). The most common US finding was a not-circumscribed, oval mass with parallel orientation and normal acoustic transmission. Microcalcifications were seen on US in 31 (81.6%) of the 38 US visible cases; this finding showed a trend of association with Van Nuys group 2 and 3 but was not statistically significant (P = 0.063). CONCLUSION When DCIS was identified on US, it was associated with more aggressive histopathologic type. However, mammographic correlation is essential to differentiate benign from malignant lesion in cases seen by US; US findings of asymptomatic DCIS had a low suspicion of malignancy.
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Affiliation(s)
- Yeon Ju Gwak
- Department of Radiology, Kyungpook National University Hospital, 200 DongDuk-Ro, Jung-Gu, Daegu 700–721
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Hospital, 200 DongDuk-Ro, Jung-Gu, Daegu 700–721
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Sang Kwon Lee
- Department of Radiology, Keimyung University Dongsan Medical Center, Daegu
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University Hospital, 200 DongDuk-Ro, Jung-Gu, Daegu 700–721
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University Hospital, 200 DongDuk-Ro, Jung-Gu, Daegu 700–721
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Hospital, 200 DongDuk-Ro, Jung-Gu, Daegu 700–721
| | - Yun-Jin Jang
- Department of Radiology, Kyungpook National University Hospital, 200 DongDuk-Ro, Jung-Gu, Daegu 700–721
| | - Man Hoon Han
- Department of Pathology, Kyungpook National University Hospital, Daegu
| | - Ji Young Park
- Department of Pathology, Kyungpook National University Hospital, Daegu
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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Gatta G, Iaselli F, Parlato V, Di Grezia G, Grassi R, Rotondo A. Differential diagnosis between fibroadenoma, giant fibroadenoma and phyllodes tumour: sonographic features and core needle biopsy. Radiol Med 2011; 116:905-18. [DOI: 10.1007/s11547-011-0672-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/20/2010] [Indexed: 11/29/2022]
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Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, Houssami N. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 2011; 260:119-28. [PMID: 21493791 DOI: 10.1148/radiol.11102368] [Citation(s) in RCA: 254] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To perform a meta-analysis to report pooled estimates for underestimation of invasive breast cancer (where core-needle biopsy [CNB] shows ductal carcinoma in situ [DCIS] and excision histologic examination shows invasive breast cancer) and to identify preoperative variables that predict invasive breast cancer. MATERIALS AND METHODS Studies were identified by searching MEDLINE and were included if they provided data on DCIS underestimates (overall and according to preoperative variables). Study-specific and pooled percentages for DCIS underestimates were calculated. By using meta-regression (random effects logistic modeling) the association between each study-level preoperative variable and understaged invasive breast cancer was investigated. RESULTS Fifty-two studies that included 7350 cases of DCIS with findings at excision histologic examination as the reference standard met the eligibility criteria and were included. There were 1736 underestimates (invasive breast cancer at excision); the random-effects pooled estimate was 25.9% (95% confidence interval: 22.5%, 29.5%). Preoperative variables that showed significant univariate association with higher underestimation included the use of a 14-gauge automated device (vs 11-gauge vacuum-assisted biopsy, P = .006), high-grade lesion at CNB (vs non-high grade lesion, P < .001), lesion size larger than 20 mm at imaging (vs lesions ≤ 20 mm, P < .001), Breast Imaging Reporting and Data System (BI-RADS) score of 4 or 5 (vs BI-RADS score of 3, P for trend = .005), mammographic mass (vs calcification only, P < .001), and palpability (P < .001). CONCLUSION About one in four DCIS diagnoses at CNB represent understaged invasive breast cancer. Preoperative variables significantly associated with understaging include biopsy device and guidance method, size, grade, mammographic features, and palpability.
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Affiliation(s)
- Meagan E Brennan
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building, Room A27, Sydney, NSW 2006, Australia.
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Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy. Eur Radiol 2011; 21:1618-27. [DOI: 10.1007/s00330-011-2103-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/04/2011] [Accepted: 02/09/2011] [Indexed: 12/21/2022]
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Tada K, Ogiya A, Kimura K, Morizono H, Iijima K, Miyagi Y, Nishimura S, Makita M, Horii R, Akiyama F, Iwase T. Ductal carcinoma in situ and sentinel lymph node metastasis in breast cancer. World J Surg Oncol 2010; 8:6. [PMID: 20105298 PMCID: PMC2837658 DOI: 10.1186/1477-7819-8-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/27/2010] [Indexed: 02/07/2023] Open
Abstract
Background The impact of sentinel lymph node biopsy on breast cancer mimicking ductal carcinoma in situ (DCIS) is a matter of debate. Methods We studied the rate of occurrence of sentinel lymph node metastasis in 255 breast cancer patients with pure DCIS showing no invasive components on routine pathological examination. We compared this to the rate of occurrence in 177 patients with predominant intraductal-component (IDC) breast cancers containing invasive foci equal to or less than 0.5 cm in size. Results Most of the clinical and pathological baseline characteristics were the same between the two groups. However, peritumoral lymphatic permeation occurred less often in the pure DCIS group than in the IDC-predominant invasive-lesion group (1.2% vs. 6.8%, p = 0.002). One patient (0.39%) with pure DCIS had two sentinel lymph nodes positive for metastasis. This rate was significantly lower than that in patients with IDC-predominant invasive lesions (6.2%; p < 0.001). Conclusions Because the rate of sentinel lymph node metastasis in pure DCIS is very low, sentinel lymph node biopsy can safely be omitted.
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Affiliation(s)
- Keiichiro Tada
- Department of Breast Surgery, Cancer Institute Hospital, Tokyo, Japan.
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