Department of Radiology, National Cancer Center, Goyang, Republic of Korea.
Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
Korean J Radiol. 2024 Oct;25(10):876-886. doi: 10.3348/kjr.2024.0268.
To develop a nomogram that integrates clinical-pathologic and imaging variables to predict ipsilateral breast tumor recurrence (IBTR) in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS).
This retrospective study included consecutive women with DCIS who underwent BCS at two hospitals. Patients who underwent BCS between 2003 and 2016 in one hospital and between 2005 and 2013 in another were classified into development and validation cohorts, respectively. Twelve clinical-pathologic variables (age, family history, initial presentation, nuclear grade, necrosis, margin width, number of excisions, DCIS size, estrogen receptor, progesterone receptor, radiation therapy, and endocrine therapy) and six mammography and ultrasound variables (breast density, detection modality, mammography and ultrasound patterns, morphology and distribution of calcifications) were analyzed. A nomogram for predicting 10-year IBTR probabilities was constructed using the variables associated with IBTR identified from the Cox proportional hazard regression analysis in the development cohort. The performance of the developed nomogram was evaluated in the external validation cohort using a calibration plot and 10-year area under the receiver operating characteristic curve (AUROC) and compared with the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram.
The development cohort included 702 women (median age [interquartile range], 50 [44-56] years), of whom 30 (4%) women experienced IBTR. The validation cohort included 182 women (48 [43-54] years), 18 (10%) of whom developed IBTR. A nomogram was constructed using three clinical-pathologic variables (age, margin, and use of adjuvant radiation therapy) and two mammographic variables (breast density and calcification morphology). The nomogram was appropriately calibrated and demonstrated a comparable 10-year AUROC to the MSKCC nomogram (0.73 vs. 0.66, = 0.534) in the validation cohort.
Our nomogram provided individualized risk estimates for women with DCIS treated with BCS, demonstrating a discriminative ability comparable to that of the MSKCC nomogram.
建立一个列线图，整合临床病理和影像学变量，以预测接受保乳手术（BCS）治疗的导管原位癌（DCIS）女性的同侧乳房肿瘤复发（IBTR）。
本回顾性研究纳入了在两家医院接受 BCS 的连续 DCIS 女性患者。一家医院 2003 年至 2016 年期间和另一家医院 2005 年至 2013 年期间接受 BCS 的患者分别被分为开发和验证队列。分析了 12 个临床病理变量（年龄、家族史、初始表现、核分级、坏死、切缘宽度、切除次数、DCIS 大小、雌激素受体、孕激素受体、放疗和内分泌治疗）和 6 个乳腺 X 线摄影和超声变量（乳腺密度、检测方式、乳腺 X 线摄影和超声模式、钙化形态和分布）。使用开发队列中的 Cox 比例风险回归分析确定与 IBTR 相关的变量，构建预测 10 年 IBTR 概率的列线图。使用校准图和 10 年接受者操作特征曲线下面积（AUROC）评估在外部验证队列中开发的列线图的性能，并与 Memorial Sloan-Kettering Cancer Center（MSKCC）列线图进行比较。
开发队列纳入 702 例女性（中位年龄[四分位间距]，50[44-56]岁），其中 30 例（4%）女性发生 IBTR。验证队列纳入 182 例女性（48[43-54]岁），其中 18 例（10%）发生 IBTR。使用三个临床病理变量（年龄、切缘和辅助放疗的使用）和两个乳腺 X 线摄影变量（乳腺密度和钙化形态）构建了一个列线图。该列线图具有适当的校准度，在验证队列中与 MSKCC 列线图的 10 年 AUROC 相当（0.73 比 0.66， = 0.534）。
我们的列线图为接受 BCS 治疗的 DCIS 女性提供了个体化的风险估计，其区分能力与 MSKCC 列线图相当。
