Risk Factor of Invasive Breast Cancer in Patients with Preoperative Diagnosis of Ductal Carcinoma in Situ

Sun Hyoung Shin; Byung Chun Kim; Young Ju Song; Hyun Chul Yoon; Jin Seong Cho; Min Ho Park; Jung Han Yoon; Young Jong Jegal

doi:10.4174/jkss.2011.80.2.90

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Shin, Kim, Song, Yoon, Cho, Park, Yoon, and Jegal: Risk Factor of Invasive Breast Cancer in Patients with Preoperative Diagnosis of Ductal Carcinoma in Situ

Original Article

Journal of Korean Spine Surg 2011;80(2):90-95.

Published online: 4 February 2011

DOI: https://doi.org/10.4174/jkss.2011.80.2.90

Risk Factor of Invasive Breast Cancer in Patients with Preoperative Diagnosis of Ductal Carcinoma in Situ

Sun Hyoung Shin, M.D., Byung Chun Kim, M.D., Young Ju Song, M.D., Hyun Chul Yoon, M.D., Jin Seong Cho, M.D., Min Ho Park, M.D., Jung Han Yoon, M.D., Young Jong Jegal, M.D.

Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea

Received 7 October 2010 Accepted 31 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Ductal carcinoma in situ (DCIS), unlike invasive ductal carcinoma, does not require sentinel lymph node biopsy or axillary lymph node dissection because the possibility of axillary lymph node metastasis is low. However, occasionally, despite preoperative diagnosis of DCIS, invasive ductal carcinoma can be diagnosed by postoperative biopsy. Therefore, a study of the associated risk factors is necessary.

Methods

198 patients with an initial diagnosis of DCIS, treated between February 2005 and December 2009, were retrospectively analyzed. Associations between clinical and pathologic factors were analyzed for significance using univariate and multivariate analyses.

Results

Of the 198 patients, 57 (28.8%) were found to have invasive disease on final pathology. Multivariate analysis revealed 4 independent predictors of invasive cancer upon final pathology: diagnosis by needle biopsy (OR, 3.165; P=0.008), positive p53 on preoperative biopsy (OR, 2.494; P=0.019) DCIS size (＞2 cm) on microscopic finding (OR, 2.683; P=0.014), and relatively young age (OR, 0.958, P=0.046). Of the 13 patients with positive axillary lymph nodes, 11 (84.6%) were shown to have invasive cancer on final pathology (P＜0.001).

Conclusion

In cases of preoperative diagnosis based on needle biopsy, positive p53, large tumor, and relatively young age, an SLNB procedure can be considered because in almost 30% of the patients an invasive carcinoma is found after surgery.

Keywords: Ductal carcinoma in situ, Invasive breast cancer

References

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Table 1.

The relation of invasiveness with age distribution, clinical presentations and operation methods

	DICS^*	Invasive carcinoma	P-value
Age
Mean age	51.7 (±10.7)	48.2 (±8.9)	0.021
Symptoms
Screening	97 (68.8%)	27 (47.4%)	0.004
Palpable mass	30 (21.3%)	21 (36.8%)	0.020
Mastalgia	3 (2.1%)	5 (8.8%)	0.046
Nipple discharge	11 (7.8%)	4 (7.0%)	0.557
Palpation by clinician	62 (44.0%)	36 (63.2%)	0.011
Operation method			0.450
BCS^†	76 (53.9%)	32 (56.1%)
Mastectomy	65 (46.1%)	25 (43.9%)
Total	141	57

^* DCIS = ductal carcinoma in situ; surgery.

^† BCS = breast conserving

Table 2.

The relation of invasiveness with tumor characteristics

	DCIS^*	Invasive carcinoma	P-value
Tumor location			0.211
Right	71 (50.4%)	33 (57.9%)
Left	70 (49.6%)	24 (42.1%)
Tumor location
Central	13 (9.2%)	1 (1.8%)	0.051
UOQ^†	58 (41.1%)	30 (52.6%)	0.094
UIQ^‡	36 (25.5%)	13 (22.8%)	0.418
LOQ^§	22 (15.6%)	8 (14.0%)	0.485
LIQ^∥	12 (8.5%)	5 (8.8%)	0.574
Number of tumor
1	127 (90.1%)	51 (89.5%)	0.541
2	4 (2.8%)	1 (1.8%)	0.552
≥3	8 (5.7%)	4 (7.0%)	0.471
Size
Mean size (mm)	17.1 (±13.5)	27.3 (±17.9)	0.009
＜2 cm	103 (73.0%)	23 (40.4%)	＜0.001
≥2 cm	38 (27.0%)	34 (59.6%)
Total	141	57

^* DCIS = ductal carcinoma in situ;

^† UOQ = upper outer quadrant;

^‡ UIQ = upper inner quadrant;

^§ LOQ = lower outer quadran;

^∥ LIQ = lower inner quadrant.

Table 3.

The relation of invasiveness with pathological subtype and molecular marker

	DCIS^*	Invasive carcinoma	P-value
Microscopic finding
Comedo type	65 (46.1%)	29 (50.9%)	0.325
Cribriform type	61 (34.3%)	10 (18.2%)	0.001
Papillary type	25 (17.9%)	6 (10.5%)	0.142
Solid type	52 (36.9%)	17 (29.8%)	0.219
Microcalcification	100 (70.9%)	35 (61.4%)	0.129
Necrosis	81 (57.4%)	41 (71.9%)	0.040
ER^†			0.073
Positive	94 (66.7%)	31 (54.4%)
Negative	47 (33.3%)	26 (45.6%)
PR^‡			0.002
Positive	93 (66.0%)	24 (42.1%)
Negative	48 (34.0%)	33 (57.9%)
p53^§			0.001
Positive	34 (27.6%)	30 (54.5%)
Negative	89 (72.4%)	25 (45.5%)
C-erb2 (3＋)	39 (27.9%)	19 (33.3%)	0.275
Nuclear grade
1 (low)	25 (19.2%)	7 (12.5%)	0.343
2(intermediate)	75 (57.7%)	34 (60.7%)	0.468
3 (high)	30 (13.1%)	15 (26.8%)	0.316
Total	141	57

^* DCIS = ductal carcinoma in situ;

^† ER = estrogen receptor;

^‡ PR = progesterone receptor;

^§ p53 = tumor protein 53.

Table 4.

The relation of invasiveness with biopsy methods

	DCIS^*	Invasive carcinoma	P-value
Core needle biopsy	64 (45.4%)	45 (78.9%)	＜0.001
Excision biopsy	77 (54.6%)	12 (21.1%)
MGB^†	39 (27.7%)	3 (5.3%)
Excision biopsy	24 (17.0%)	7 (12.3%)
Mammotome	14 (9.9%)	2 (3.5%)
Total	141	57

^* DCIS = ductal carcinoma in situ;

^† MGB = mammography guided excision biopsy.

Table 5.

Univariate and multivariate analysis of predictors of in vasive breast cancer in patients with initial diagnosis o ductal carcinoma in situ

	P-value		^Odd ratio
	Univariate analysis	Multivariate analysis	^Odd ratio
Age	0.021	0.046	0.958
Not detect by screening	0.004	0.368	1.457
Palpation by clinician	0.011	0.569	1.281
Tumor size ＞2 cm	＜0.001	0.014	2.683
Cribroform type	0.001	0.098	2.063
Necrosis	0.040	0.393	1.422
PR(−)^*	0.002	0.396	1.414
p53(＋)^†	0.001	0.019	2.494
Needle biopsy	＜0.001	0.008	3.165

^* PR = progesterone receptor;

^† p53 = tumor protein 53.

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