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Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy

 Hyung Seok Park  ;  Seho Park  ;  JungHoon Cho  ;  Ji Min Park  ;  Seung Il Kim  ;  Byeong-Woo Park 
 JOURNAL OF SURGICAL ONCOLOGY, Vol.107(4) : 388-392, 2013 
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Adult ; Aged ; Axilla ; Biomarkers, Tumor/analysis ; Biopsy, Large-Core Needle* ; Breast Neoplasms/diagnosis* ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Carcinoma, Intraductal, Noninfiltrating/diagnosis* ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Carcinoma, Intraductal, Noninfiltrating/surgery ; Factor Analysis, Statistical ; Female ; Humans ; Logistic Models ; Lymph Nodes/pathology* ; Lymphatic Metastasis/diagnosis ; Mammography ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Predictive Value of Tests ; Preoperative Period ; Risk Assessment ; Risk Factors ; Sentinel Lymph Node Biopsy* ; Ultrasonography, Mammary
BACKGROUND: Diagnosis of ductal carcinoma in situ (DCIS) by core needle biopsy showed a high rate of underestimation of invasiveness, and performing sentinel lymph node biopsy (SLNB) in DCIS patients was controversial. METHODS: We analyzed 340 DCIS patients who were diagnosed by needle biopsies. Final pathology and clinicopathological features were reviewed. Predictors were accessed using the Chi-square test and a binary logistic regression model. RESULTS: The overall DCIS underestimation rate was 42.6%. The underestimation was significantly related to the palpability, mass or calcification by ultrasonography, grade, suspicious microinvasion, and biopsy method in univariate analysis. In multivariate analysis, palpability, ultrasonographic calcification or mass, suspicious microinvasion, and core needle biopsy were independent predictors of underestimation of invasive cancer. In cases with one or no risk predictors, the underestimation rate was 14.3%, whereas, in those with five predictors, it increased to 90.9%. Among 144 invasive cancer patients who underwent axillary staging, 15.4% had node metastasis. CONCLUSIONS: DCIS diagnosed by preoperative needle biopsy has a high probability of underestimation, and 15% of invasive cancer patients have node metastasis. SLNB may be justified in DCIS patients undergoing needle biopsies, and caution should be exercised in omitting SLNB in patients with one or no risk predictors.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Il(김승일)
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Park, Ji Min(박지민)
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Cho, Jung Hoon(조정훈)
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