Predictive value of extent and grade of ductal carcinoma in situ in radiologically guided core biopsy for the status of margins in lumpectomy specimens

doi:10.1053/ejso.2000.0975

European Journal of Surgical Oncology (EJSO)

Volume 26, Issue 7, November 2000, Pages 646-651

https://doi.org/10.1053/ejso.2000.0975 Get rights and content

Abstract

Aims The correlation between the extent and grade of ductal carcinoma in situ (DCIS) in a core needle biopsy of breast, and the presence of an extensive intraductal carcinoma component (EIC) or positive resection margins in a subsequent mastectomy, has not been adequately addressed in the literature. Materials and methods Seventy-eight core needle biopsies with mammography and mastectomy correlation (27 total mastectomies, 51 lumpectomies) were reviewed. The extent and grade of DCIS in the biopsies were determined and compared with the mammographic findings and the status of the EIC and margins in subsequent mastectomy specimens. Results Twenty-four cases of core biopsies with at least three foci of low-grade DCIS or at least two foci of high grade DCIS (group I) corresponded in large part to cases of mastectomy with a positive EIC (20/23 cases, or predictive value of 87%). Nine of 15 cases of lumpectomy in this group were associated with margins positive for or close to (less than 0.1 cm from) carcinoma. Thirty-three cases of core biopsies with one or two foci of low-grade DCIS or one focus of high-grade DCIS (group II) were associated with mastectomies with a limited extent of DCIS. Only four of 22 lumpectomy specimens in this group had margins positive for or close to carcinoma. Twenty-one cases of core biopsies without DCIS (group III) represented all five mastectomy specimens without DCIS, and 16 mastectomies with DCIS and negative EIC. None of the 14 cases of lumpectomy in this group had margins positive for carcinoma. The predictive value for EIC status may be even higher if mammographic findings are used in cases with a low number of foci (two foci of low-grade DCIS or one focus of high-grade DCIS in short biopsy cores). Conclusions There was a good correlation between the extent and grade of DCIS in core biopsies and the status of EIC in subsequent mastectomy specimens. Core needle biopsies with at least three foci of low-grade DCIS or at least two foci of high-grade DCIS are associated with a greater likelihood of positive or close margins in subsequent lumpectomies. Core biopsies without DCIS are associated with a greater likelihood of negative margins in subsequent lumpectomies.

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Cited by (22)

Mass-forming ductal carcinoma in situ: An ultrasonographic and histopathologic correlation study
2022, Pathology Research and Practice
Citation Excerpt :
We found that this group had the significant likelihood of missed invasive carcinoma than that of the other categories on follow-up excision, with an upgrade rate of 35% (p < 0.05). One limitation of our study was that we did not evaluate the significance of DCIS histologic features on CNBs as a predictor of margin status or the maximal pathology in the subsequent excisions, as former studies have already reported on this topic [28–32]. In conclusion, we categorized four mass-forming DCIS groups following US CNB for mass-forming lesions with a diagnosis of DCIS.
Ultrasound (US) guided core needle biopsy (CNB) for mass lesions resulting in a diagnosis of ductal carcinoma in situ (DCIS) is often considered radiologically discordant and generates surgical planning difficulty. One hundred cases of US-guided CNB for mass lesions diagnosed as DCIS were collected from 2013 to 2021. Histological features were reviewed and correlated with radiology and surgical excision findings. Thirty (30%) were high-grade (HG), and seventy (70%) were low- to intermediate-grade. Seventy-one (71%) cases had a histological correlate of a mass-forming lesion, including 26 (26%) were associated with benign mass-forming lesions (category 1) such as papilloma, complex sclerosing lesion/radial scar, fibroadenoma, sclerosing adenosis, and ruptured cyst; 23 (23%) were HG with solid pattern, comedo necrosis, and stromal desmoplasia (category 2); and 22 (22%) had predominantly papillary architecture (category 3). Twenty-nine (29%) were discordant with no histologic correlate of a mass lesion (category 4). Follow-up excisions were available in 79 cases. Invasive carcinoma was identified in 14 cases (18%), of which 8 were from the radiologically discordant category (35%), 3 (17%) associated with HG DCIS with desmoplasia, 2 (10%) associated with benign mass lesion and 1(5%) was predominantly papillary architecture. US-guided CNB for mass-forming lesions with a DCIS diagnosis on CNB can be grouped into four categories. Radiology-pathology correlation is essential. This categorization emphasized rad-path correlation and had a clear difference in upgrade rate on follow-up excision. Rad-path discordant biopsy cases were more likely to be associated with a missed invasive carcinoma (p < 0.05).
Predictive factors associated with involved margins in breast cancer treated with neoadjuvant chemotherapy followed by breast-conserving therapy
2019, Journal of Gynecology Obstetrics and Human Reproduction
: This study sought to identify predictive factors of involved surgical margins in breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) to help guide the surgical procedure.
: Retrospective study of patients who had BCS after NAC between January 2008 and December 2013. Outcome measure: tumor-involved margin, defined by tumor cells on ink for invasive cancer and tumor-free margin < 2 mm for DCIS.
: Ninety-seven patients were included. The median age of patients was 46 years old [28–71]. The initial average tumor size was 47.8 mm [+/- 18.6]. Twelve patients (12.4%) had involved tumor margins on final histology after BCS and NAC. According to the multivariate model including only preoperative variables of positive margins, initial ultrasound tumor size ≤ 27 mm (p = 0.045) and low SBR grade (p = 0.009) were independently associated with tumor-involved margins. According to the multivariate model including pre- and postoperative variables of positive margins, ductal carcinomain situ was also independently associated with tumor-involved margins (p = 0.021).
: Initial ultrasound tumor size ≤ 27 mm and low SBR grade were independently associated with tumor-involved margins. These preoperative data were very helpful to guide the surgical procedure in breast cancer.
Diagnostic Pathology: Breast
2017, Diagnostic Pathology: Breast
Does the volume of ductal carcinoma in situ impact the positive margin rate in patients undergoing breast conservation for invasive breast cancer?
2013, Journal of Surgical Research
Citation Excerpt :
Mai et al. studied the extent and grade of DCIS in core needle biopsy specimens and the association with positive surgical margins. Core needle biopsies with at least three foci of low-grade DCIS or at least two foci of high-grade DCIS were associated with a greater likelihood of positive or close margins in the subsequent lumpectomy specimens [17]. Core biopsy pathology was not available in the present study, but future prospective studies may be helpful in more clearly delineating the pathologic features of DCIS in core specimens and the final surgical margin outcomes.
We sought to investigate whether the volume of ductal carcinoma in situ (DCIS) impacts margin status in patients undergoing lumpectomy for invasive breast cancer.
We identified 358 patients with stages I–III invasive breast cancer and associated DCIS who were treated with breast-conserving therapy from 1999 to 2009. Data included patient and tumor characteristics, percentage of DCIS (<25%, 26%–50%, or >50%), and pathologic outcomes. Data were compared using chi-square and Fisher exact tests. A two-tailed P value of <0.05 was considered significant.
The 358 patients had a mean age of 58 ± 13 y; 260 (72%) patients were >50 y. The volume of DCIS in lumpectomy specimens was <25% in 296 (83%) patients, 26%–50% in 29 (8%) patients, and >50% in 33 (9%) patients. Tumors with decreasing DCIS volume were more likely to be estrogen receptor positive (239 [82%] with <25% DCIS, 21 [72%] with 26%–50% DCIS, 22 [67%] with >50% DCIS; P = 0.026). DCIS volume was not significantly associated with patient age, tumor size, grade, and stage, nodal status, progesterone receptor status, or Her2 status (P > 0.05). Overall, 137 (38%) patients had one or more positive margins, including 97 of 296 (33%) with <25% DCIS volume, 17 of 29 (59%) with 26%–50% DCIS volume, and 23 of 33 (70%) with >50% DCIS volume (P < 0.0001).
The volume of DCIS associated with an invasive breast cancer in the final lumpectomy specimen is a strong predictor of positive surgical margins. Future analyses will focus on the ability of core pathology to provide this information for intraoperative surgical decision making.
Pre-treatment imaging and pathology characteristics of invasive breast cancers of limited extent: Potential relevance for MRI-guided localized therapy
2012, Radiotherapy and Oncology
Identifying breast cancers of limited extent (BCLE) is becoming increasingly important, especially for (image guided) minimally invasive therapy and partial breast irradiation. The purpose of this study is to establish characteristics at functional imaging and pathology associated with invasive BCLE.
Seventy-five patients (77 breasts) with invasive breast cancer were prospectively included. Excision specimens were processed using complete embedding. Microscopic findings were reconstructed and correlated with contrast-enhanced MRI. Tumors were stratified by absence or presence of occult disease ⩾10 mm from the MRI-visible lesion: BCLE and non-BCLE, respectively. Imaging and pathology characteristics were evaluated for their ability to discriminate between BCLE and non-BCLE. Multivariate binary logistic regression was employed to create a prediction model for BCLE.
At univariate analysis, imaging as well as pathology characteristics were indicative for BCLE (39/77 = 51%). At multivariate analysis, a mass on mammography, the absence of tumor washout, positive ER and low quantity of DCIS in the index tumor retained significance (area under ROC curve = 0.87).
Pre-treatment assessment of mammography findings, MRI washout kinetics, ER status and quantity of DCIS in the index tumor has the potential to accurately identify BCLE.
Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery
2008, Modern Pathology
Selection of patients for breast-conserving surgery relies on inexact parameters such as the preoperative estimation of lesion size. This study investigates the value of needle core biopsy findings, in particular, the relative quantity of DCIS, in improving patient selection for breast conservation. Patients undergoing breast-conserving surgery for invasive ductal carcinoma from 1999 to 2004 were identified. Only patients who had a preoperative diagnosis of carcinoma (DCIS and invasive) on core biopsy were included. All core biopsies were reviewed by a breast histopathologist to document the quantity and characteristics of the DCIS component. Of a total of 281 patients, 46% (n=129) had invasive disease on core biopsy (group 1) and 54% (n=152) had either invasive disease with an accompanying DCIS component or DCIS only on core biopsy (group 2). The compromised margin rate for group 1 was 23% compared to 39% for group 2 (P=0.004). The rate of compromised margins increased progressively as the core biopsy DCIS component increased until a rate of 75% (n=18/24) was reached in patients with DCIS only on core biopsy. In patients with a DCIS component on core biopsy, the presence of necrosis (P=0.002), solid type architecture (P=0.008), high grade DCIS (P=0.007), calcification (P=0.003), and the relative proportion of DCIS present (P<0.001) were associated with compromised margins on univariate analysis. On multivariate analysis of this subgroup, the proportion of DCIS in this subgroup (P=0.048) was an independent predictor of compromised margins. The presence and relative proportion of DCIS on core biopsy provides important information as to whether patients are at risk of compromised margins. Documentation of these parameters may assist patient selection for breast-conserving surgery or identify patients who may benefit from wider margins at the time of initial operation.

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^☆: Correspondence to: Dr K. T. Mai, Anatomical Pathology, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9. Tel: +1 (613) 761-4344; Fax: +1 (613) 761-4846; E-mail: [email protected]

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European Journal of Surgical Oncology (EJSO)

Abstract

References (26)

Controversies in the local management of invasive and non-invasive breast cancer

Cancer Lett

Ductal carcinoma in situ. The success of breast conservation therapy: a shared experience of two single institutional nonrandomized prospective studies

Surg Oncol Clin North Am

The impact of tumor size and histology on local control after breast-conserving therapy

Radiother Oncol

Prediction of local recurrence of ductal carcinoma in situ of the breast using five histological classifications: a comparative study with long follow-up

Hum Pathol

Can the clinical and mammographic findings at presentation predict the presence of an extensive intraductal component in early stage breast cancer?

Int J Radiat Oncol Biol Phys

The diagnostic accuracy of core biopsy in palpable and non-palpable breast lesions

Eur J Radiol

Future prospects in limited surgery for early breast cancer

Sem Surg Oncol

Clinical and radiological predictors of complete excision in breast-conserving surgery for primary breast cancer

Aust NZ J Surg

Reanalysis and results after 12 years follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer [see comments]

N Engl J Med

Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy

Cancer

Comparison of partial and modified radical mastectomy in the community setting ««10 years later»»

Can J Surg

The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy

Ann Surg

[Prognostic value of determination of the presence and histologic grade of the intraductal component in invasive ductal carcinoma of the breast after conservation treatment]

Lijec Vjesn

Cited by (22)

Mass-forming ductal carcinoma in situ: An ultrasonographic and histopathologic correlation study

Predictive factors associated with involved margins in breast cancer treated with neoadjuvant chemotherapy followed by breast-conserving therapy

Diagnostic Pathology: Breast

Does the volume of ductal carcinoma in situ impact the positive margin rate in patients undergoing breast conservation for invasive breast cancer?

Pre-treatment imaging and pathology characteristics of invasive breast cancers of limited extent: Potential relevance for MRI-guided localized therapy

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

Regular ArticlePredictive value of extent and grade of ductal carcinoma in situ in radiologically guided core biopsy for the status of margins in lumpectomy specimens☆

Abstract

Cancer Lett

Surg Oncol Clin North Am

Radiother Oncol

Hum Pathol

Int J Radiat Oncol Biol Phys

Eur J Radiol

Future prospects in limited surgery for early breast cancer

Sem Surg Oncol

Clinical and radiological predictors of complete excision in breast-conserving surgery for primary breast cancer

Aust NZ J Surg

Reanalysis and results after 12 years follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer [see comments]

N Engl J Med

Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy

Cancer

Comparison of partial and modified radical mastectomy in the community setting ««10 years later»»

Can J Surg

The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy

Ann Surg

[Prognostic value of determination of the presence and histologic grade of the intraductal component in invasive ductal carcinoma of the breast after conservation treatment]

Lijec Vjesn

Regular Article
Predictive value of extent and grade of ductal carcinoma in situ in radiologically guided core biopsy for the status of margins in lumpectomy specimens☆