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影像学和病理学预测因素可使乳腺导管原位癌(DCIS)术后升级为浸润性导管癌和淋巴结转移;淋巴结手术降级的潜在算法。

Radiological and pathological predictors of post-operative upstaging of breast ductal carcinoma in situ (DCIS) to invasive ductal carcinoma and lymph-nodes metastasis; a potential algorithm for node surgical de-escalation.

机构信息

Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133, Rome, (RM), Italy.

Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133, Rome, (RM), Italy; Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, Rome, RM, Italy.

出版信息

Surg Oncol. 2024 Oct;56:102128. doi: 10.1016/j.suronc.2024.102128. Epub 2024 Aug 30.

Abstract

BACKGROUND/AIM: Ductal carcinoma in situ is considered a local disease with no metastatic potential, thus sentinel lymph node biopsy (SLNB) may be deemed an overtreatment. SLNB should be reserved for patients with invasive cancer, even though the risk of upstaging rises to 25 %. We aimed to identify clinicopathological predictors of post-operative upstaging in invasive carcinoma.

METHODS

We retrospectively analyzed patients with a pre-operative diagnosis of DCIS subjected to breast surgery between January 2017 to December 2021, and evaluated at the Breast Unit of PTV (Policlinico Tor Vergata, Rome).

RESULTS

Out of 267 patients diagnosed with DCIS, 33(12.4 %) received a diagnosis upstaging and 9(3.37 %) patients presented with sentinel lymph node (SLN) metastasis. In multivariate analysis, grade 3 tumor (OR 1.9; 95 % CI 1.2-5.6), dense nodule at mammography (OR 1.3; 95 % CI 1.1-2.6) and presence of a solid nodule at ultrasonography (OR 1.5; 95 % CI 1.2-2.6) were independent upstaging predictors. Differently, the independent predictors for SLNB metastasis were: upstaging (OR 2.1.; 95 % CI 1.2-4.6; p = 0.0079) and age between 40 and 60yrs (OR 1.4; 95 % CI 1.4-2.7; p = 0.027). All 9 patients with SLN metastasis received a diagnosis upstaging and were aged between 40 and 60 years old.

CONCLUSION

We identified pre-operative independent predictors of upstaging to invasive ductal carcinoma. The combined use of different predictors in an algorithm for surgical treatments of DCIS could reduce the numbers of unnecessary SLNB.

摘要

背景/目的:导管原位癌被认为是一种局部疾病,没有转移的潜力,因此前哨淋巴结活检(SLNB)可能被视为过度治疗。SLNB 应保留给患有浸润性癌的患者,尽管升级的风险上升到 25%。我们旨在确定浸润性癌术后升级的临床病理预测因子。

方法

我们回顾性分析了 2017 年 1 月至 2021 年 12 月期间在罗马 PTV (波利克里托·托尔·韦尔加塔)乳腺科接受乳腺手术的术前诊断为 DCIS 的患者,并进行了评估。

结果

在 267 例诊断为 DCIS 的患者中,有 33 例(12.4%)诊断升级,9 例(3.37%)患者有前哨淋巴结(SLN)转移。多变量分析显示,3 级肿瘤(OR 1.9;95%CI 1.2-5.6)、乳腺 X 线照相术上的致密结节(OR 1.3;95%CI 1.1-2.6)和超声检查中的实性结节(OR 1.5;95%CI 1.2-2.6)是独立的升级预测因子。不同的是,SLNB 转移的独立预测因子为:升级(OR 2.1;95%CI 1.2-4.6;p=0.0079)和 40-60 岁年龄(OR 1.4;95%CI 1.4-2.7;p=0.027)。9 例 SLN 转移患者均被诊断为升级,年龄在 40-60 岁之间。

结论

我们确定了术前独立的浸润性导管癌升级预测因子。在 DCIS 的手术治疗中,不同预测因子的联合使用可以减少不必要的 SLNB 数量。

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