Zhan Haiying, Quinn Marie, Tian Wanqing, Yan Li, Khoury Thaer
Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Am J Clin Pathol. 2021 Sep 8;156(4):596-606. doi: 10.1093/ajcp/aqaa276.
This study aims to investigate the consequences of comedonecrosis omission as an exclusion criterion of the Comparison of Operative vs Monitoring and Endocrine Therapy (COMET) trial.
The clinical inclusion criteria of the COMET trial were applied on women who were mammographically screened between 2007 and 2017 and had a diagnosis of low- or intermediate-grade ductal carcinoma in situ (DCIS). The percentage of ductal diameter occupied by necrosis was calculated.
Twenty-six of 129 (20.2%) cases were upgraded. Larger calcification span correlated with upgrade (P = .02), with the best cutoff of 1.1 cm, and negative predictive value of 86%. When solely analyzing cases with no comedonecrosis (n = 76), none of the variables correlated with upgrade. Comedonecrosis was significantly correlated with upgrade to invasive carcinoma (P = .041), with the best cutoff of 53% of ductal diameter occupied by necrosis.
Results indicate that comedonecrosis and span of mammographic calcifications could be risk factors in women managed with active surveillance.
本研究旨在调查粉刺性坏死遗漏作为手术与监测及内分泌治疗比较（COMET）试验排除标准的后果。
COMET试验的临床纳入标准应用于2007年至2017年间接受乳腺钼靶筛查且诊断为低级别或中级别导管原位癌（DCIS）的女性。计算坏死占据的导管直径百分比。
129例病例中有26例（20.2%）级别上调。更大的钙化范围与级别上调相关（P = 0.02），最佳截断值为1.1 cm，阴性预测值为86%。仅分析无粉刺性坏死的病例（n = 76）时，没有变量与级别上调相关。粉刺性坏死与升级为浸润性癌显著相关（P = 0.041），坏死占据导管直径的最佳截断值为53%。
结果表明，粉刺性坏死和乳腺钼靶钙化范围可能是接受主动监测女性的危险因素。
