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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2019

Open Access 01-11-2019 | Breast Cancer | Epidemiology

Reliability of preoperative breast biopsies showing ductal carcinoma in situ and implications for non-operative treatment: a cohort study

Authors: Gurdeep S. Mannu, Emma J. Groen, Zhe Wang, Michael Schaapveld, Esther H. Lips, Monica Chung, Ires Joore, Flora E. van Leeuwen, Hendrik J. Teertstra, Gonneke A. O. Winter-Warnars, Sarah C. Darby, Jelle Wesseling

Published in: Breast Cancer Research and Treatment | Issue 2/2019

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Abstract

Purpose

The future of non-operative management of DCIS relies on distinguishing lesions requiring treatment from those needing only active surveillance. More accurate preoperative staging and grading of DCIS would be helpful. We identified determinants of upstaging preoperative breast biopsies showing ductal carcinoma in situ (DCIS) to invasive breast cancer (IBC), or of upgrading them to higher-grade DCIS, following examination of the surgically excised specimen.

Methods

We studied all women with DCIS at preoperative biopsy in a large specialist cancer centre during 2000–2014. Information from clinical records, mammography, and pathology specimens from both preoperative biopsy and excised specimen were abstracted. Women suspected of having IBC during biopsy were excluded.

Results

Among 606 preoperative biopsies showing DCIS, 15.0% (95% confidence interval 12.3–18.1) were upstaged to IBC and a further 14.6% (11.3–18.4) upgraded to higher-grade DCIS. The risk of upstaging increased with presence of a palpable lump (21.1% vs 13.0%, pdifference = 0.04), while the risk of upgrading increased with presence of necrosis on biopsy (33.0% vs 9.5%, pdifference < 0.001) and with use of 14G core-needle rather than 9G vacuum-assisted biopsy (22.8% vs 7.0%, pdifference < 0.001). Larger mammographic size increased the risk of both upgrading (pheterogeneity = 0.01) and upstaging (pheterogeneity = 0.004).

Conclusions

The risk of upstaging of DCIS in preoperative biopsies is lower than previously estimated and justifies conducting randomized clinical trials testing the safety of active surveillance for lower grade DCIS. Selection of women with low grade DCIS for such trials, or for active surveillance, may be improved by consideration of the additional factors identified in this study.
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Metadata
Title
Reliability of preoperative breast biopsies showing ductal carcinoma in situ and implications for non-operative treatment: a cohort study
Authors
Gurdeep S. Mannu
Emma J. Groen
Zhe Wang
Michael Schaapveld
Esther H. Lips
Monica Chung
Ires Joore
Flora E. van Leeuwen
Hendrik J. Teertstra
Gonneke A. O. Winter-Warnars
Sarah C. Darby
Jelle Wesseling
Publication date
01-11-2019
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2019
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-019-05362-1

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