Abstract
Purpose
It is still unclear which patients diagnosed with DCIS through biopsy can benefit from lymph node surgery. We aimed to developed and validated a nomogram to predict the risk of upstaging to invasion, and explore the factors related to lymph node metastasis in biopsy diagnosis of DCIS patients.
Methods
A retrospective study was conducted on 526 cases diagnosed with DCIS before surgery in the period of January 2016 to December 2022. Nomograms for predicting the probability of invasion disease were constructed according to multivariate logistic regression analysis. This nomogram was validated using a second data set of 133 patients between January to December 2023. Univariate and multivariate analysis were used to evaluate the risk factors for lymph node metastasis.
Results
Underestimating invasive carcinoma occurred in 42.0% of patients, of whom 37 had positive lymph node. Core needle biopsy, mass on mammography, moderate nuclear grade of DCIS and increased Ki-67 expression were associated with upstaging. Nomogram developed depending on these factors showed acceptable performance on predicting upstaging (AUC 0.724). This nomogram was validated in a second dataset with an AUC of 0.641. calcification on mammography, mass on MRI performance and large radiological size were independent risk factors of lymph node metastasis.
Conclusion
Underestimating invasive carcinoma with DCIS detected prior to surgery is common, but with a low probability of lymph node metastasis. This nomogram and factors associated with positive lymph node may provide help in selecting suitable patients for axillary lymph node excision.