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Predictors
of Invasion in Patients With Core-Needle Biopsy-Diagnosed Ductal Carcinoma
in Situ
Among patients with core-needle biopsy (CNB) diagnosed ductal carcinoma in situ (DCIS), the guidelines for the selection of patients to undergo sentinel lymph node (SLN) surgery are not well defined. Advocates note that SLN surgery, at least for a selected group of high-risk DCIS patients, avoids the need for a second operation for patients who prove to have invasive disease on final excision. However, SLN surgery in all patients with high-risk DCIS, the majority of whom do not actually have invasive disease, would mean subjecting many patients to unnecessary treatment. The objective of our study was to identify the predictors of invasion in patients with CNB-diagnosed DCIS and, thus, help to determine the most appropriate candidates for SLN surgery. Parameters that correlated with subsequent invasion upon excision in our study were a mass lesion, size of tumor >1.5 cm, high nuclear grade and the presence of lobular cancerization by ductal carcinoma in situ on CNB. Using the 4 significant variables that we identified as associated with invasion, we developed a multivariate logistic regression model to predict invasion on CNB and, hence, to allow a more selective approach to SLN surgery. If it is applied clinically, then this model may help to reduce the number of patients who undergo unnecessary SLN surgery
Bibliographic reference:
Erika Resetkova Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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