Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients. (December 2021)

• Record Type: Journal Article
• Authors: Yan, Mingfei; Bomeisl, Phillip; Gilmore, Hannah; Harbhajanka, Aparna
• Is Part Of: International journal of surgical pathology. Volume 29:Number 8(2021)
• Page Start: 836
• Page End: 843
• Publication Date: 2021-12
• Subjects: breast -- DCIS -- upgrading risk -- ER/PR/HER2 status -- axillary lymph node metastasis; Pathology, Surgical -- Periodicals; 617.07
• DOI: 10.1177/10668969211012088
• Languages: English
• ISSNs: 1066-8969

Abstract

Stratifying ductal carcinoma in situ (DCIS) patients into different upgrading risk groups is important in exploiting more precise therapeutic options. Evaluation of estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status and axillary lymph node metastatic status for DCIS and their upgraded invasive counterparts can also provide diagnostic and therapeutic implications. We retrospectively studied 575 patients with first-time diagnosis of DCIS on biopsies, and followed up their final diagnosis, ER/PR/HER2 status, and axillary lymph node involvement on excisions. As a result, biopsy-diagnosed DCIS had an overall 19.1% risk to be upgraded on subsequent excisions, with 4.7% being upgraded to microinvasive carcinoma (pT1mi) and 14.4% to overt invasive carcinoma (⩾pT1a). Factors significantly associated with higher upgrading risk on multivariate analysis include biopsy guidance by ultrasound ( P <.001), DCIS with suspicious microinvasion ( P < .001), and DCIS diagnosed in left breast ( P = .026). DCIS diagnosed in younger patients (⩽40 years old) or DCIS with high nuclear grade showed higher upgrading risk only on univariate analysis. About 80% ER + /PR + and ER− /PR− DCIS remained the same ER/PR status after being upgraded, and ER + /PR − DCIS had the highest risk (63.6%) of having HER2 amplification in upgraded invasive carcinoma. For upgraded DCIS, microinvasive carcinoma was more likely to have HER2 amplification (50%) than overt invasive carcinoma (29.5%). Besides, pure DCIS had a low risk of axillary lymph node macrometastasis (0.74%), while the risk increased in DCIS with microinvasion (4.4%) and was highest in overt invasive carcinoma (14.7%). The findings of this study are clinically relevant with respect to criteria that might be used in selecting patients for de-escalation trials.