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Predictive value of ductal carcinoma in situ with invasive breast cancer in core needle biopsies for final pathologic size of intraductal elements

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Abstract

Preoperative evaluations of the size of ductal carcinoma in situ (DCIS) extension in invasive breast cancer (IBC) are problematic and markers of the actual size of DCIS remain elusive. This study aimed to quantify DCIS on core needle biopsy (CNB) and investigated its association with degree of DCIS extension on paired resection specimens, instead of with presence or absence of an extensive intraductal component or margin status as in earlier studies. This series examined 150 IBCs diagnosed from paired CNB and resection specimens. The DCIS/invasion ratio was calculated using the sum of each element size from CNB. In resection specimens, cases in which the greatest dimension of DCIS extension was longer than the greatest dimension of invasive size were defined as extended DCIS (Ext-DCIS). DCIS/invasion ratio level correlated positively with the degree of Ext-DCIS (P = 0.003). Using receiver operating characteristic curve analysis, setting cases with the subgroup of DCIS extension with greatest dimension > 2.5 times that of the invasive size in the resection specimen (Ext-DCIS > 2.5) as the positive class provided the best discrimination ability for DCIS/invasion ratio (0.375). In multivariate analysis, DCIS/invasion ratio > 0.375 was significantly associated with Ext-DCIS > 2.5 (P = 0.033). In conclusion, DCIS/invasion ratio > 0.375 in CNB was identified as a predictor of Ext-DCIS > 2.5 in resection specimens, suggesting that an approach combining DCIS/invasion ratio from CNB with preoperative staging may better predict the extent of DCIS and facilitate better surgical planning.

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References

  1. Berg WA, Gutierrez L, NessAiver MS, Bradford Carter W, Bhargavan M, Lewis RS, Ioffe OB (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849. https://doi.org/10.1148/radiol.2333031484

    Article  PubMed  Google Scholar 

  2. Daniel OK, Lim SM, Kim JH, Park HS, Park S, Kim SI (2017) Preoperative prediction of the size of pure ductal carcinoma in situ using three imaging modalities as compared to histopathological size: does magnetic resonance imaging add value? Breast Cancer Res Treat 164:437–444. https://doi.org/10.1007/s10549-017-4252-2

    Article  PubMed  Google Scholar 

  3. Sharifi S, Peterson MK, Baum JK, Raza S, Schnitt SJ (1999) Assessment of pathologic prognostic factors in breast core needle biopsies. Mod Pathol 12:941–945

    CAS  PubMed  Google Scholar 

  4. Arnedos M, Nerurkar A, Osin P, A’Hern R, Smith IE, Dowsett M (2009) Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). Ann Oncol 20:1948–1952. https://doi.org/10.1093/annonc/mdp234

    Article  CAS  PubMed  Google Scholar 

  5. Chen X, Yuan Y, Zhaoxiang Gu, Shen K (2012) Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis. Breast Cancer Res Treat 134:957–967. https://doi.org/10.1007/s10549-012-1990-z

    Article  CAS  PubMed  Google Scholar 

  6. College of American Pathologists. Cancer Protocol Templates. https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates. Accessed 25 June 2021

  7. Elizabeth M, Hammond H, Hayes DF, Mitch Dowsett D, Allred C, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, Hicks DG, Lester S, Love R, Mangu PB, McShane L, Keith Miller C, Osborne K, Paik S, Perlmutter J, Rhodes A, Sasano H, Schwartz JN, Sweep FCG, Taube S, Torlakovic EE, Valenstein P, Viale G, Visscher D, Thomas Wheeler R, Williams B, Wittliff JL, Wolff AC (2010) American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28:2784–2795. https://doi.org/10.1200/JCO.2009.25.6529

    Article  Google Scholar 

  8. Wolff AC, Elizabeth M, Hammond H, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, Bartlett JMS, Bilous M, Fitzgibbons P, Hanna W, Jenkins RB, Mangu PB, Paik S, Perez EA, Press MF, Spears PA, Vance GH, Viale G, Hayes DF, American Society of Clinical Oncology; College of American Pathologists (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31:3997–4013. https://doi.org/10.1200/JCO.2013.50.9984

    Article  PubMed  Google Scholar 

  9. Wolff AC, Elizabeth Hale Hammond M, Allison KH, Harvey BE, Mangu PB, Bartlett JMS, Bilous M, Ellis IO, Fitzgibbons P, Hanna W, Jenkins RB, Press MF, Spears PA, Vance GH, Viale G, McShane LM, Dowsett M (2018) Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol 36:2105–2122. https://doi.org/10.1200/JCO.2018.77.8738

    Article  CAS  PubMed  Google Scholar 

  10. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  11. Jimenez RE, Bongers S, Bouwman D, Segel M, Visscher DW (2000) Clinicopathologic significance of ductal carcinoma in situ in breast core needle biopsies with invasive cancer. Am J Surg Pathol 24:123–128. https://doi.org/10.1097/00000478-200001000-00015

    Article  CAS  PubMed  Google Scholar 

  12. Mai KT, Yazdi HM, Ford JC, Matzinger FR (2000) Predictive value of extent and grade of ductal carcinoma in situ in radiologically guided core biopsy for the status of margins in lumpectomy specimens. Eur J Surg Oncol 26:646–651. https://doi.org/10.1053/ejso.2000.0975

    Article  CAS  PubMed  Google Scholar 

  13. Dzierzanowski M, Melville KA, Barnes PJ, MacIntosh RF, Caines JS, Porter GA (2005) Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal component and lumpectomy margins. J Surg Oncol 90:71–76. https://doi.org/10.1002/jso.20242

    Article  PubMed  Google Scholar 

  14. Dillon MF, Maguire AA, McDermott EW, Myers C, Hill ADK, O’Doherty A, Quinn CM (2008) Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery. Mod Pathol 21:39–45. https://doi.org/10.1038/modpathol.3800975

    Article  PubMed  Google Scholar 

  15. Barbalaco Neto G, Rossetti C, Fonseca FL, Valenti VE, de Abreu LC (2012) Ductal carcinoma in situ in core needle biopsies and its association with extensive in situ component in the surgical specimen. Int Arch Med 5:19. https://doi.org/10.1186/1755-7682-5-19

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen RB (1984) Pathologic predictors of early local recurrence in Stage I and II breast cancer treated by primary radiation therapy. Cancer 53:1049–1057. https://doi.org/10.1002/1097-0142(19840301)53:5%3c1049::aid-cncr2820530506%3e3.0.co;2-o

    Article  CAS  PubMed  Google Scholar 

  17. Schnitt SJ, Connolly JL, Khettry U, Mazoujian G, Brenner M, Silver B, Recht A, Beadle G, Harris JR (1987) Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy. Cancer 59:675–681. https://doi.org/10.1002/1097-0142(19870215)59:4%3c675::aid-cncr2820590402%3e3.0.co;2-u

    Article  CAS  PubMed  Google Scholar 

  18. Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, Silver B, Hetelekidis S, Abner A, Harris JR, Schnitt SJ (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 18:1668–1675. https://doi.org/10.1200/JCO.2000.18.8.1668

    Article  CAS  PubMed  Google Scholar 

  19. Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, Eberlein TJ, Mayzel K, Silver B, Harris JR (1994) The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer 74:1746–1751. https://doi.org/10.1002/1097-0142(19940915)74:6%3c1746::aid-cncr2820740617%3e3.0.co;2-y

    Article  CAS  PubMed  Google Scholar 

  20. Houssami N, Petra Macaskill M, Luke Marinovich J, Dixon M, Irwig L, Brennan ME, Solin LJ (2010) Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer 46:3219–3232. https://doi.org/10.1016/j.ejca.2010.07.043

    Article  PubMed  Google Scholar 

  21. Luke Marinovich M, Azizi L, Macaskill P, Irwig L, Morrow M, Solin LJ, Houssami N (2016) The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol 23:3811–3821. https://doi.org/10.1245/s10434-016-5446-2

    Article  PubMed  PubMed Central  Google Scholar 

  22. Uematsu T, Yuen S, Kasami M, Uchida Y (2008) Comparison of magnetic resonance imaging, multidetector row computed tomography, ultrasonography, and mammography for tumor extension of breast cancer. Breast Cancer Res Treat 112:461–474. https://doi.org/10.1007/s10549-008-9890-y

    Article  PubMed  Google Scholar 

  23. Amano G, Ohuchi N, Ishibashi T, Ishida T, Amari M, Satomi S (2000) Correlation of three-dimensional magnetic resonance imaging with precise histopathological map concerning carcinoma extension in the breast. Breast Cancer Res Treat 60:43–55. https://doi.org/10.1023/a:1006342711426

    Article  CAS  PubMed  Google Scholar 

  24. Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, Hanby A, Brown J (2010) Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet 375:563–571. https://doi.org/10.1016/S0140-6736(09)62070-5

    Article  PubMed  Google Scholar 

  25. Thomassin-Naggara I, Pascale Siles I, Trop JC, Darai E, Bazot M, Uzan S (2013) How to measure breast cancer tumoral size at MR imaging? Eur J Radiol 82:e790-800. https://doi.org/10.1016/j.ejrad.2013.08.002

    Article  CAS  PubMed  Google Scholar 

  26. Lai H-W, Chen D-R, Yao-Chung Wu, Chen C-J, Lee C-W, Kuo S-J, Chen S-T, Hwa-Koon Wu (2015) Comparison of the Diagnostic Accuracy of Magnetic Resonance Imaging with Sonography in the Prediction of Breast Cancer Tumor Size: A Concordance Analysis with Histopathologically Determined Tumor Size. Ann Surg Oncol 22:3816–3823. https://doi.org/10.1245/s10434-015-4424-4

    Article  PubMed  Google Scholar 

  27. Choi WJ, Cha JH, Kim HH, Shin HJ, Chae EY (2016) The Accuracy of Breast MR Imaging for Measuring the Size of a Breast Cancer: Analysis of the Histopathologic Factors. Clin Breast Cancer 16:e145–e152. https://doi.org/10.1016/j.clbc.2016.07.007

    Article  PubMed  Google Scholar 

  28. Girometti R, Marconi V, Linda A, Di Mico L, Bondini F, Zuiani C, Sardanelli F (2020) Preoperative assessment of breast cancer: Multireader comparison of contrast-enhanced MRI versus the combination of unenhanced MRI and digital breast tomosynthesis. Breast 49:174–182. https://doi.org/10.1016/j.breast.2019.11.013

    Article  PubMed  Google Scholar 

  29. Di Pasquale GL, De Jesús J, Xiong Y, Rosa M (2020) Tumor size and focality in breast carcinoma: Analysis of concordance between radiological imaging modalities and pathological examination at a cancer center. Ann Diagn Pathol 48:151601. https://doi.org/10.1016/j.anndiagpath.2020.151601

    Article  Google Scholar 

  30. Kurniawan ED, Wong MH, Windle I, Rose A, Mou A, Buchanan M, Collins JP, Miller JA, Gruen RL, Bruce Mann G (2008) Predictors of surgical margin status in breast-conserving surgery within a breast screening program. Ann Surg Oncol 15:2542–2549. https://doi.org/10.1245/s10434-008-0054-4

    Article  PubMed  Google Scholar 

  31. Shin H-C, Han W, Moon H-G, Cho N, Moon WK, Park I-A, Park SJ, Noh D-Y (2012) Nomogram for predicting positive resection margins after breast-conserving surgery. Breast Cancer Res Treat 134:1115–1123. https://doi.org/10.1007/s10549-012-2124-3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, Nakagami Hospital, Okinawa, 904-2195, Japan

    Hirofumi Matsumoto, Akiko Ishii & Norihiro Nakada

  2. Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan

    Ayako Koki, Mikiko Unesoko, Norie Abe & Hisamitsu Zaha

Authors
  1. Hirofumi Matsumoto
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  2. Akiko Ishii
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  3. Norihiro Nakada
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  4. Ayako Koki
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  5. Mikiko Unesoko
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  6. Norie Abe
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  7. Hisamitsu Zaha
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Contributions

The study was designed by Hirofumi Matsumoto. The manuscript was written by Hirofumi Matsumoto. Hirofumi Matsumoto performed statistical analyses. Hisamitsu Zaha, Norie Abe, Mikiko Unesoko, and Ayako Koki collected clinical data and samples. Hirofumi Matsumoto, Norihiro Nakada, and Akiko Ishii were involved in the pathological diagnoses. All authors reviewed and approved the manuscript.

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Correspondence to Hirofumi Matsumoto.

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This study was part of a research project approved by the ethics committees at Nakagami Hospital (2015001–1) and the study was conducted according to the World Medical Association Declaration of Helsinki ethics principles.

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The authors declare no competing interests.

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Matsumoto, H., Ishii, A., Nakada, N. et al. Predictive value of ductal carcinoma in situ with invasive breast cancer in core needle biopsies for final pathologic size of intraductal elements. Virchows Arch 480, 739–748 (2022). https://doi.org/10.1007/s00428-021-03243-x

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  • DOI: https://doi.org/10.1007/s00428-021-03243-x

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