Massachusetts General Hospital/Department of Radiology, 55 Fruit Street, WAC 240, Boston, MA 02114.
Massachusetts General Hospital/Department of Surgery, Boston, MA.
Acad Radiol. 2021 Mar;28(3):e71-e76. doi: 10.1016/j.acra.2020.02.011. Epub 2020 Mar 26.
To determine the upgrade rate of noncalcified ductal carcinoma in situ (DCIS) and features that are associated with risk of upgrade to invasive disease at surgery.
A retrospective review was conducted of consecutive women who were diagnosed with noncalcified DCIS from January 2007 to December 2016. Patient demographics, imaging findings, biopsy pathology results, and surgical outcomes were reviewed. The unpaired t test, chi-square test, and Fisher's exact test were used to compare features between the cases of DCIS that did and did not upgrade to invasive carcinoma at surgery.
Over a 10-year period, 78 women (mean age 62 years, range 30-88 years) were diagnosed with noncalcified DCIS. Two-thirds (67.9%, 53/78) of cases were detected on screening mammography, and 15.4% (12/78) of diagnoses were made after presentation with an area of palpable concern. The most common mammographic presentations of noncalcified DCIS were mass (51.3%, 40/78) and asymmetry (30.8%, 24/78). Seventeen cases (21.8%, 17/78) were upgraded to invasive ductal carcinoma (IDC) at surgery. Features associated with upgrade risk included older patient age (68.1 versus 60.3 years, OR 1.08, p < 0.01) and family history of breast cancer in a first-degree relative (41.2% [7/17] versus 16.4% [10/61], OR 3.57, p = 0.03).
In our study cohort, the upgrade rate of noncalcified DCIS to IDC at surgery is 21.8%. Upgrade risk is associated with older patient age and family history of breast cancer in a first-degree relative.
本研究旨在明确非钙化性导管原位癌（DCIS）的升级率，以及与手术时升级为浸润性疾病相关的特征。
回顾性分析 2007 年 1 月至 2016 年 12 月期间连续诊断为非钙化性 DCIS 的女性患者。评估患者的人口统计学特征、影像学表现、活检病理结果和手术结局。采用独立样本 t 检验、卡方检验和 Fisher 确切概率法比较 DCIS 患者中未升级为浸润性癌与升级为浸润性癌患者的特征差异。
在 10 年期间，共诊断出 78 例非钙化性 DCIS 患者（平均年龄 62 岁，范围 30-88 岁）。67.9%（53/78）的病例在筛查性乳房 X 线摄影中发现，15.4%（12/78）的病例因可触及的病灶就诊。非钙化性 DCIS 的最常见的 X 线表现为肿块（51.3%，40/78）和不对称（30.8%，24/78）。17 例（21.8%，17/78）患者在手术时升级为浸润性导管癌（IDC）。与升级风险相关的特征包括患者年龄较大（68.1 岁比 60.3 岁，OR 1.08，p<0.01）和一级亲属乳腺癌家族史（41.2%[7/17]比 16.4%[10/61]，OR 3.57，p=0.03）。
在本研究队列中，非钙化性 DCIS 手术时升级为 IDC 的比例为 21.8%。升级风险与患者年龄较大和一级亲属乳腺癌家族史相关。
