Prediction of upstaging in DCIS: the dominant role of pathological over imaging risk factors.

IF 3 3区医学 Q2 ONCOLOGY

Breast Cancer Research and Treatment Pub Date : 2025-10-01 Epub Date: 2025-08-01 DOI:10.1007/s10549-025-07768-6

Sunhyung Choi, Bombi Park, Eun-Gyeong Lee, Seeyoun Lee, Han-Sung Kang, So-Youn Jung, Dong-Eun Lee, Jai-Hong Han

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引用次数: 0

Abstract

Purpose: Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer with variable risk of upstaging to invasive carcinoma. Accurate preoperative risk stratification is critical to guide management decisions and minimize overtreatment. This study aimed to identify clinicopathological and imaging predictors of DCIS upstaging to invasive cancer.

Methods: We conducted a retrospective analysis of 701 patients diagnosed with DCIS, among whom 200 (28.5%) were upstaged to microinvasive or invasive carcinoma. Logistic regression was used to evaluate the association between upstaging and various factors, including tumor size, nuclear grade, comedo necrosis, progesterone receptor (PR) negativity, human epidermal growth factor receptor 2 (HER2) overexpression, and mammographic findings.

Results: Tumor size > 5 cm, comedo necrosis, PR negativity, and mammographic microcalcifications were independent predictors of upstaging. While HER2 overexpression was significant in univariate analysis, it was not retained in the multivariate model. Non-mass lesions on ultrasound and magnetic resonance imaging (MRI) were not significant predictors.

Conclusion: Integrating these markers into preoperative risk stratification models may improve individualized treatment planning and reduce overtreatment in patients with DCIS.

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预测DCIS的抢先期：病理危险因素对影像危险因素的主导作用。

目的：导管原位癌（Ductal carcinoma in situ， DCIS）是一种非浸润性乳腺癌，其发展为浸润性癌的风险不同。准确的术前风险分层是指导管理决策和减少过度治疗的关键。本研究旨在确定DCIS先于浸润性癌症的临床病理和影像学预测因素。方法：对701例DCIS患者进行回顾性分析，其中200例（28.5%）为微创或侵袭性癌。采用Logistic回归评估占位与多种因素的关系，包括肿瘤大小、核分级、痤疮坏死、孕激素受体（PR）阴性、人表皮生长因子受体2 （HER2）过表达和乳房x线检查结果。结果：肿瘤大小bbb50 cm，粉刺坏死，PR阴性和乳房x线微钙化是前分期的独立预测因素。虽然HER2过表达在单因素分析中是显著的，但在多因素模型中没有保留。超声和磁共振成像（MRI）上的非肿块性病变不是显著的预测因子。结论：将这些指标纳入术前风险分层模型可改善DCIS患者的个体化治疗计划，减少过度治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Breast Cancer Research and Treatment 医学-肿瘤学

CiteScore

6.80

自引率

2.60%

发文量

342

审稿时长

1 months

期刊介绍： Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.