Factors Of Pathological Underestimation Of Ductal Carcinoma In Situ And Atypical Ductal Hyperplasia Diagnosed By Core Needle Biopsy

Objectives: The present study tried to identify factors predictive of upstaging from ultrasound-guided core needle biopsy(CNB)-diagnosed ductal carcinoma in situ(DCIS)or atypical ductal hyperplasia to invasive cancer after surgical excision.Methods: From January 2016 to October 2020,we enrolled 398 female patients with DCIS or ADH diagnosed by CNB and performed subsequent surgical resection.The patients who underwent biopsy and surgical resection were analyzed retrospectively.Ultrasonography guided CNB was performed using a 16-gauge needle automated gun method.We devided all enrolled patients into DCIS(166),DCIS suspicious invasion(47),ADH suspicious caicinoma(85),ADH(100)according to the result of the CNB.All patients received systematic therapy for breast cancer.The correlation between clinicopathological characteristics and underest-imation was counted with Chisquare test.The risk factors of underestimation in pure DCIS were analyzed by binary logistic regression.Results: The total upgrade rate was 42.46%(169/398).In the ADH group,breast imaging reporting and data system(BI-RADS)categories is independently associated with upstaging(4Bvs5:OR 0.054,P<0.001;4Cvs5:OR 0.078,P=0.001).In the ADH suspicious caicinoma group,tumor size on ultrasonography(diameter≤ 2cm vs diameter>2cm: OR 0.347,P 0.040)and BI-RADS categories(4Avs5: OR 0.042,P 0.008;4Bvs5: OR 0.151,P0.013;4Cvs5: OR 0.262,P 0.032)are independently associated with upstaging;In the DCIS group,tumor size on ultrasonography(diameter≤2cm vs diameter>2cm:OR 0.368,P 0.015)and BI-RADS categories(4Avs5: OR0.031,P 0.001;4Bvs5:OR 0.040,P <0.001;4Cvs5:OR 0.143,P <0.001)are independently associated with upstaging;In the DCIS suspicious invasion,tumor size on ultrasonography(diameter≤2cm vs diameter>2cm:OR0.165,P 0.048)are independently associated with upstaging.Among patients with axillary metastasis,0.87%(2/229),and 11.83%(20/169)were in the non-upstaging and IBC groups,respectively.Conclusions: For patients initially diagnosed with ADH by CNB,higher BI-RADS category and larger tumor size on ultrasonography(> 2 cm)were independent predictive factors of upstaging on final pathology;For patients initially diagnosed with DCIS and ADH suspicious caicinoma by CNB,higher BI-RADS category and larger tumor size on ultrasonography(> 2 cm)were independent predictive factors of upstaging on final pathology.Thus,SLNB of patients who don’t have those characteristic may be omitted for the little downstream risk of upstaging.