Sonographic Lesion Size of Ductal Carcinoma In Situ as a Preoperative Predictor for the Presence of an Invasive Focus

Abstract

BACKGROUND AND OBJECTIVES: To investigate the preoperative factors associated with upstage to invasive cancer in patients with core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) by ultrasound guidance alone. METHODS: Between 2000 and 2007, 201 patients with DCIS diagnosed at 11- or 14-gauge CNB by ultrasound guidance alone were examined. Preoperative factors were all analyzed to correlate with the presence of invasive cancer after definitive resection. The Pearson chi-square test and stratified analysis with the Mantel-Haenszel chi-squire test were used to assess the association between the preoperative factors and upstage to invasive cancer. RESULTS: Compared with the overall underestimation rate (84 of 201, 41.8%), 47 (60.3%) of 78 patients with abnormal breast palpation, 46 (55.4%) of 83 patients with mammographic finding of a mass lesion, and 38 (67.9%) of 56 patients with a sonographic lesion size >20 mm had invasive cancer components on the final pathology review (Odds ratio [OR] = 2.45; P = 0.04, OR = 3.66; P = 0.002, and OR = 4.13; P = 0.002 respectively). CONCLUSION: A sonographic lesion size >20 mm can be used as another guideline for surgeons to consider sentinel lymph node biopsy in patients with DCIS diagnosed by a sonographically guided CNB.