Predictive factors of upstaging DCIS to invasive carcinoma in BCT vs mastectomy

BACKGROUND

Upstaging from DCIS to invasive ductal carcinoma varies widely from 0 to 59%. We aim to identify risk factors associated with upstaging in all DCIS patients and based on specific surgical intervention.

METHODS

Patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy were reviewed. Multivariable analysis was performed to identify risk factors for upstaging.

RESULTS

In total, 623 patients had a preoperative diagnosis of DCIS. Upstaging occurred in 74 patients (12%) overall. There was no difference in upstaging rates between mastectomy and BCT (11% v 14% p = 0.27). Sentinel lymph node biopsy was positive in 4/212 patients (1%). Multivariable analysis revealed suspicion of microinvasion (OR 5.7 95%CI2.2-14.9), surgeon suspicion of invasive disease (OR 2.7, 95% CI 1.2-6.4) and larger size/multicentric/extensive tumor (OR 1.9 95% CI 1.1-3.4) increase risk of upstaging.

CONCLUSIONS

Suspicion of microinvasion, surgeon suspicion, and tumor size can be used to help guide the use of sentinel lymph node biopsy. For patients without these high risk characteristics, it is hard to justify the use of concurrent SLN biopsy for patients who undergo BCT.

Clinical importance of unilaterally enlarging lymph nodes on otherwise normal mammograms

PURPOSE

To determine the clinical importance of unilateral enlargement of axillary or intramammary lymph nodes on otherwise normal mammograms.

MATERIALS AND METHODS

Twenty-four patients (aged 33-76 years) with unilaterally enlarging lymph nodes on otherwise normal mammograms were identified in a review of mammographic reports from 1991 to 1995. Mammograms, medical history, follow-up findings, and biopsy results were reviewed.

RESULTS

The initial nodal size was 3-17 mm. The size increased by 20%-312%. Seven patients had a history of malignancy. Six patients had a clinical history suggestive of a benign cause of nodal enlargement. Seven patients underwent biopsy. Two patients had results positive for malignancy (one, melanoma; one, lymphoma). Both patients had a known history of malignancy and a size increase of greater than 100%. In 17 patients, mammographic follow-up findings at 6-58 months (mean, 26 months) showed decreased nodal size in 13 and no change in four patients.

CONCLUSION

Enlarging lymph nodes on otherwise normal mammograms are usually benign. Clinical history can reveal possible causes of nodal enlargement. If the patient has no history of malignancy, the amount of nodal size increase is small, and the node maintains a benign appearance, mammographic follow-up is a reasonable alternative to biopsy.