Table 2.
Numbers of preoperative biopsies of DCIS and final diagnosis following evaluation of surgically excised specimen by various characteristics
| Characteristic | Final diagnosis from surgically excised specimen | ||||||
|---|---|---|---|---|---|---|---|
| Total number of biopsies | Number upstaged to IBC (%) | p for upstage versus no change† | Total number of biopsies eligible for upgrading* | Number upgraded to a higher grade of DCIS (%) | p for upgrade versus no change† | p for upgrade versus upstage† | |
| Age at diagnosis (years) | |||||||
| 20–49 | 196 | 35(17.9) | 0.43 | 131 | 21 (16.0) | 0.09 | 0.21 |
| 50–59 | 247 | 35 (14.2) | 169 | 29 (17.2) | |||
| 60–69 | 119 | 17 (14.3) | 78 | 5 (6.4) | |||
| 70 + | 44 | 4 (9.1) | 27 | 4 (14.8) | |||
| Method of biopsy | |||||||
| 9G VAC | 237 | 26 (11.0) | 0.07 | 171 | 12 (7.0) | < 0.001 | 0.14 |
| 14G Core-needle | 127 | 21 (16.5) | 79 | 18 (22.8) | |||
| Unknown | 242 | 44 | 155 | 29 | |||
| Mammographic lesion size (mm) | |||||||
| 0–19 | 180 | 15 (8.3) | 0.004 | 145 | 15 (10.3) | 0.01 | 0.53 |
| 20–50 | 144 | 27 (18.8) | 77 | 12 (15.6) | |||
| ≥ 50 | 99 | 19 (19.2) | 63 | 16 (25.4) | |||
| Unknown | 183 | 30 | 120 | 16 | |||
| Pathological lesion size (mm) | |||||||
| 0–19 | 201 | 14 (7.0) | <0.001 | 151 | 14 (9.3) | < 0.001 | 0.07 |
| 20–50 | 181 | 37 (20.4) | 106 | 26 (24.5) | |||
| ≥ 50 | 107 | 21 (19.6) | 62 | 16 (25.8) | |||
| Unknown | 117 | 19 | 86 | 3 | |||
| Mammographic lesion type | |||||||
| Microcalcifications only | 490 | 68 (13.9) | 0.08 | 327 | 45 (13.8) | 0.33 | 0.87 |
| Other | 97 | 20 (20.6) | 65 | 12 (18.5) | |||
| Unknown | 19 | 3 | 13 | 2 | |||
| Radiological BIRADS score | |||||||
| ≤ 4 | 323 | 4 (12.7) | 0.02 | 242 | 25(10.3) | 0.03 | 0.54 |
| 5 | 47 | 12 (25.5) | 19 | 5 (26.3) | |||
| Other | 236 | 38 | 144 | 29 | |||
| Method of presentation | |||||||
| Screen-detected | 324 | 41 (12.7) | 0.35 | 229 | 34 (14.8) | 0.62 | 0.32 |
| Symptomatic | 74 | 13 (17.6) | 41 | 4 (9.8) | |||
| Othera | 208 | 37 | 135 | 21 | |||
| Presence of symptoms at examinationb | |||||||
| Symptoms | 175 | 35 (20.0) | 0.02 | 99 | 14 (14.1) | 0.86 | 0.12 |
| No symptoms | 223 | 25 (11.2) | 156 | 25 (16.0) | |||
| Unknown | 208 | 31 | 150 | 20 | |||
| Presence of palpable lump | |||||||
| Yes | 114 | 24 (21.1) | 0.04 | 64 | 11 (17.2) | 0.31 | 0.81 |
| No | 454 | 59 (13.0) | 315 | 42 (13.3) | |||
| Unknown | 38 | 8 | 26 | 6 | |||
| Presence of necrosis on preoperative biopsy | |||||||
| Yes | 208 | 38 (18.3) | 0.09 | 97 | 32 (33.0) | < 0.001 | < 0.001 |
| No | 370 | 52 (14.1) | 285 | 27 (9.5) | |||
| Unknown | 28 | 1 | 23 | 0 | |||
| Preoperative biopsy gradec | |||||||
| 1-Low | 155 | 16 (10.3) | 0.17 | 155 | 22 (14.2) | 0.66 | 0.46 |
| 2-Intermediate | 250 | 42 (16.8) | 250 | 37 (14.8) | |||
| 3-High | 191 | 30 (15.7) | – | – | |||
| Unknown | 10 | 3 | 0 | 0 | |||
| Total 606 (%, 95% confidence interval) | 606 | 91 (15.0,12.3-18.1) | 405* | 59 (14.6, 11.3–18.4) | |||
DCIS ductal carcinoma in situ, IBC invasive breast cancer, BIRADS breast imaging reporting and data system, VAC vacuum assisted biopsy
*As only preoperative biopsies showing grade 1 or 2 could be upgraded to a higher grade of DCIS, preoperative biopsies showing grade 3 (n = 191) or unknown grade (n = 10) were not included in the analysis of factors associated with upgrading, but were included in the analysis of factors associated with upstaging
†Unknown values were omitted from tests of association
aIncludes 143 biopsies undertaken during breast surgical follow-up, 63 undertaken for second opinion and 2 unknowns
bAny symptoms in either ipsilateral or contralateral breast
cOf the 22 low grade DCIS preoperative biopsies that were upgraded based on the surgically excised specimen 20 were upgraded to intermediate grade DCIS and 2 were upgraded to high grade DCIS