Oncology Research Unit, CHU de Québec Research Centre, 1050 chemin Ste-Foy, Quebec City, QC, Canada, G1S 4L8.
Anticancer Res. 2014 Mar;34(3):1183-91.
BACKGROUND/AIM: Ductal carcinoma in situ (DCIS) is a non-invasive malignant breast lesion. Patients diagnosed with a DCIS on percutaneous biopsy usually undergo resection, and the final pathology may reveal that the lesion was in fact invasive (upgrading at surgery), this leading to treatment strategy change during its course. The aim of the present study was to identify factors associated with DCIS-upgrading to invasive carcinoma at surgery, and to identify a subgroup of patients more likely to have an invasive cancer.
A retrospective study was performed in patients diagnosed with DCIS on percutaneous biopsy between April 1997 and December 2010. Based on available data and on previous studies, 21 clinical, radiological and pathological variables were evaluated using univariate analyses. Variables identified in univariate analyses, when p≤0.10, were included in a multivariate model.
Among 608 DCIS lesions, 177 (29.1%) were invasive carcinomas after surgery. Using univariate analyses, core needle biopsy (odds ratio (OR)=1.8), physical symptoms (OR=2.9), palpable masses (OR=4.1), number of specimen obtained (1-9 cores, OR=2.2) and a measurable mammographic lesion (OR=1.7) were significantly associated with upgrading at surgery. However, using multivariate analysis, no factor was significantly associated.
No characteristic was identified to be independently associated with DCIS upgrading at surgery, and no sub-group of patients could be identified in whom the appropriate surgery could have been performed first.
背景/目的：导管原位癌（DCIS）是一种非浸润性恶性乳腺病变。经皮穿刺活检诊断为 DCIS 的患者通常需要进行切除，而最终的病理可能显示病变实际上是浸润性的（手术时升级），这导致了治疗策略的改变。本研究的目的是确定与手术时 DCIS 升级为浸润性癌相关的因素，并确定更有可能患有浸润性癌的患者亚组。
对 1997 年 4 月至 2010 年 12 月期间经皮穿刺活检诊断为 DCIS 的患者进行回顾性研究。基于现有数据和先前的研究，使用单因素分析评估了 21 个临床、放射学和病理学变量。在单因素分析中 p≤0.10 的变量被纳入多因素模型。
在 608 例 DCIS 病变中，177 例（29.1%）在手术后为浸润性癌。使用单因素分析，空心针活检（比值比（OR）=1.8）、躯体症状（OR=2.9）、可触及肿块（OR=4.1）、获取标本数量（1-9 个芯，OR=2.2）和可测量的乳腺 X 线病变（OR=1.7）与手术时升级显著相关。然而，使用多因素分析，没有因素与升级显著相关。
没有特征可以独立与手术时 DCIS 升级相关，也无法确定可以首先进行适当手术的患者亚组。
