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Identification of Factors That Will Predict Invasion on Excision Specimens in Patients With Stereotactic Core-Needle-Biopsy-Diagnosed DCIS
Laura S Dominici, K. Greg Chang, Jyotsna Kakullavarapu, Rebecca Yang
Lahey Clinic Medical Center, Burlington, MA

Objective: To identify pathologic and clinical features on stereotactic core-needle biopsy-diagnosed DCIS that will predict subsequent invasive disease on surgical excision.
Design: Retrospective review. Demographic data and histological features were correlated with invasion on subsequent excision.
Setting: Multi-specialty group practice and tertiary care hospital. Approximately 600 breast surgeries performed per year.
Patients: 160 consecutive female patients with core-needle biopsy diagnosed DCIS who underwent subsequent surgical excision at this institution between March 2002 and November 2006.
Main Outcome Measures: Presence of invasive cancer found on subsequent surgical excision specimen.
Results: 26 of 160 patients (16.3%) had invasive cancer on subsequent surgical excision. Higher histological grade was found to correlate with the presence of invasion. Biopsies with Grade 2 or 3 DCIS were significantly more likely to be invasive (p=0.006). The presence of a palpable mass was associated with invasive disease, although not statistically significantly (p=0.09). Comedonecrosis, hormone positivity, prior hormone use, family history of breast cancer and personal history of breast cancer were not found to be significant predictors. At the time of subsequent excision, 78 (48%) of patients underwent a sentinel lymph node biopsy, 19 had invasion on subsequent excision and 7 had a positive sentinel lymph node.
Conclusions: A higher histological grade was found to be predictive of invasion in patients with DCIS. Other factors such as comedonecrosis and hormone receptor status were not significant. Presence of a palpable mass was associated but not significant. These findings may assist in subsequent operative planning including the decision to perform a sentinel lymph node biopsy.


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