Department of General Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
Department of Biostatistics, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
Am J Surg. 2019 Jun;217(6):1025-1029. doi: 10.1016/j.amjsurg.2018.12.069. Epub 2019 Feb 23.
Upstaging from DCIS to invasive ductal carcinoma varies widely from 0 to 59%. We aim to identify risk factors associated with upstaging in all DCIS patients and based on specific surgical intervention.
Patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy were reviewed. Multivariable analysis was performed to identify risk factors for upstaging.
In total, 623 patients had a preoperative diagnosis of DCIS. Upstaging occurred in 74 patients (12%) overall. There was no difference in upstaging rates between mastectomy and BCT (11% v 14% p = 0.27). Sentinel lymph node biopsy was positive in 4/212 patients (1%). Multivariable analysis revealed suspicion of microinvasion (OR 5.7 95%CI2.2-14.9), surgeon suspicion of invasive disease (OR 2.7, 95% CI 1.2-6.4) and larger size/multicentric/extensive tumor (OR 1.9 95% CI 1.1-3.4) increase risk of upstaging.
Suspicion of microinvasion, surgeon suspicion, and tumor size can be used to help guide the use of sentinel lymph node biopsy. For patients without these high risk characteristics, it is hard to justify the use of concurrent SLN biopsy for patients who undergo BCT.
从 DCIS 升级为浸润性导管癌的比例差异很大，从 0 到 59%不等。我们旨在确定与所有 DCIS 患者升级相关的风险因素，并根据特定的手术干预进行分类。
回顾了术前诊断为 DCIS 并接受 BCT 或乳房切除术的患者。进行多变量分析以确定升级的风险因素。
共有 623 例患者术前诊断为 DCIS。总体而言，74 例（12%）发生升级。乳房切除术和 BCT 之间的升级率没有差异（11%比 14%，p=0.27）。212 例患者中有 4 例（1%）前哨淋巴结活检阳性。多变量分析显示怀疑微浸润（OR 5.7，95%CI2.2-14.9）、外科医生怀疑浸润性疾病（OR 2.7，95%CI 1.2-6.4）和更大的肿瘤大小/多灶性/广泛肿瘤（OR 1.9，95%CI 1.1-3.4）增加升级风险。
怀疑微浸润、外科医生怀疑和肿瘤大小可用于指导前哨淋巴结活检的使用。对于没有这些高危特征的患者，对于接受 BCT 的患者，很难证明同时进行 SLN 活检是合理的。
