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

AbstractPurposeThe 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.MethodsWe 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.ResultsAmong 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 
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research

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Abstract To clarify the surgical outcomes of breast cancer patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) (abbreviated as CNBDCIS), we retrospectively analyzed the cases of 131 patients with CNBDCIS who underwent surgery at Oomoto Hospital (32 total mastectomies, 99 conservative mastectomies). Our analysis of underestimation and predictors of invasive breast cancer of CNBDCIS revealed that the underestimation rate of CNBDCIS was 40.5% (53/131). A logistic regression analysis revealed that palpable tumors (yes to no, odds ratio [OR] 3.25), mammography (MMG) cat...
Source: Acta Med Okayama - Category: Universities & Medical Training Authors: Tags: Acta Med Okayama Source Type: research
Normally, when a physician notices a suspicious mass or lesion on a mammogram, he or she will request an ultrasound to explore it further. Based on those results, a biopsy may be performed to determine whether the mass is cancerous. “Unfortunately, right now, in some cases, physicians either overdiagnose or underdiagnose based on that biopsy, because with ultrasound they can only see so much,” said Lori Chmura, CEO of Dune Medical Devices. “The doctor is essentially going in blindly, trying to see what looks like the most suspicious area, and they’re t...
Source: MDDI - Category: Medical Devices Authors: Tags: Business Source Type: news
ConclusionsDBT-guided biopsy for architectural distortion detected a malignancy in 19% of lesions, demonstrating the importance of pathologic diagnosis for lesions without correlating ultrasound findings.
Source: The American Journal of Surgery - Category: Surgery Source Type: research
ConclusionsWe found that the prediction model established using microcalcifications radiomics signatures and clinical imaging characteristics has the potential to identify an understaging of invasive breast cancer.
Source: International Journal of Computer Assisted Radiology and Surgery - Category: Intensive Care Source Type: research
This study included 3,609,569 screening mammograms performed from 2002 to 2015 in our organized breast cancer screening program, which actively invites women 50 –69 years of age. The association between women’s characteristics and the DCIS detection rate, the IBC detection rate and the odds ratio of DCIS among screen-detected cancers was assessed by logistic regression and generalized estimating equations with independent correlation matrix and sandwic h estimator.ResultsA total of 4173 DCIS and 15,136 IBC were screen-detected. Increasing women ’s age, current hormone replacement therapy use and high...
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research
Conclusions High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
CONCLUSIONS: Although a carcinoma within a preexisting benign fibroepithelial tumor is extremely rare, it is important to be aware of the possibility of invasive and metastatic disease. PMID: 29460095 [PubMed - as supplied by publisher]
Source: Breast Cancer - Category: Cancer & Oncology Authors: Tags: Breast Cancer Source Type: research
Author Affiliations open 1Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA 2Social &Scientific Systems, Inc., Durham, North Carolina, USA 3Westat, Durham, North Carolina, USA 4Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway 5Biostatistics and Computational Biology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA PDF Version (548 KB) Abstract About This Article Supplemental Material Bac...
Source: EHP Research - Category: Environmental Health Authors: Tags: Research Source Type: research
Conclusion: For lesions initially described as BI-RADS 3 and 4a with a histological diagnosis of fibroadenoma after biopsy, short-term follow-up can be avoided.Breast Care 2017;12:238-242
Source: Breast Care - Category: Cancer & Oncology Source Type: research
A 44-year-old woman was found to have 2 groups of calcifications within the left breast on routine screening mammogram: one at 2 o'clock measuring 28  mm and a second at 3 o'clock measuring 40 mm. Follow-up diagnostic mammogram confirmed multiple groups of pleomorphic calcifications spanning>7  cm in the upper outer quadrant. Stereotactic core needle biopsy noted invasive carcinoma, predominantly lobular type, grade 2, estrogen receptor positive (Allred 8), progesterone receptor positive (Allred 8), HER2 negative (0) at the 2 o'clock site; and ductal carcinoma in situ without invasion a t 3 o'clock.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Gray Zone Source Type: research
More News: Breast Cancer | Breast Carcinoma | Breast Needle Aspiration | Cancer | Cancer & Oncology | Carcinoma | Carcinoma in Situ | Clinical Trials | DCIS (Ductal Carcinoma in Situ) | Ductal Carcinoma | Mammography | Pathology | Study | Women