Breast Ductal Carcinoma In Situ Diagnosed By Ultrasound Guided Core Needle Biopsy-Risk Predictors For Pathological Escalation

Background: The major concern over preoperatively diagnosed ductal carcinoma in situ(DCIS)of breast via ultrasound guided core needle biopsy(USCNB)is the risk of missing concomitant invasive carcinoma.It is crucial to identify risk predictors for such a phenomenon and evaluate its impact on axillary conditions to help surgeons determine which patients should receive appropriate axillary lymph node management.Methods: Medical records of 260 patients preoperatively diagnosed with DCIS via USCNB were retrospectively analyzed.All of them were successively divided into invasive and non-invasive groups,and metastatic and non-metastatic groups according to pathology of resected specimens and metastasis of axillary lymph node(ALN).Predictive value of preoperative physical examination results,imaging findings,histopathological findings,and hematological indexes for pathological escalation and ALN metastasis was assessed by logistic regression analysis.Results: The concomitant invasive carcinoma was overlooked in 75 out of 260 patients(29.3%).Logistic analysis revealed that presence of microinvasion,presence of abnormal lymph node on ultrasound,and linear or segmental distributed calcification on X ray were independent predictors for pathological escalation.Fourteen patients had lymph node metastasis,and five of them were in the non-invasive group.The presence of abnormal lymph node on ultrasound and increased ratio of platelet distribution width to platelet crit(PDW/PCT)(>52.85)were identified as independent risk predictors for ALN metastasis.Conclusion: 1.For patients with breast ductal carcinoma in situ preoperatively diagnosed by ultrasound-guided core needle biopsy,the presence of microinvasion and abnormal axillary lymph nodes on ultrasound indicate an increased risk of postoperative pathologic escalation,while the presence of linear or segmental distributed calcifications on X ray indicate a decreased risk.2.The presence of abnormal lymph node on ultrasound and the increased ratio of platelet distribution width to platelet crit(PDW/PCT)indicate an increased risk of lymph node metastasis.3.For patients with characteristics mentioned above,appropriate management of axillary lymph nodes is necessary.