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Lee SE, Kim GR, Han K, Kim EH, Kim EK, Kim MJ, Yoon JH, Park VY, Moon HJ. US, Mammography, and Histopathologic Evaluation to Identify Low Nuclear Grade Ductal Carcinoma in Situ. Radiology 2022; 303:276-284. [PMID: 35166586 DOI: 10.1148/radiol.211425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Low nuclear grade ductal carcinoma in situ (DCIS) identified at biopsy can be upgraded to intermediate to high nuclear grade DCIS at surgery. Methods that confirm low nuclear grade are needed to consider nonsurgical approaches for these patients. Purpose To develop a preoperative model to identify low nuclear grade DCIS and to evaluate factors associated with low nuclear grade DCIS at biopsy that was not upgraded to intermediate to high nuclear grade DCIS at surgery. Materials and Methods In this retrospective study, 470 women (median age, 50 years; interquartile range, 44-58 years) with 477 pure DCIS lesions at surgical histopathologic evaluation were included (January 2010 to December 2015). Patients were divided into the training set (n = 330) or validation set (n = 147) to develop a preoperative model to identify low nuclear grade DCIS. Features at US (mass, nonmass) and at mammography (morphologic characteristics, distribution of microcalcification) were reviewed. The upgrade rate of low nuclear grade DCIS was calculated, and multivariable regression was used to evaluate factors for associations with low nuclear grade DCIS that was not upgraded later. Results A preoperative model that included lesions manifesting as a mass at US without microcalcification and no comedonecrosis at biopsy was used to identify low nuclear grade DCIS, with a high area under the receiver operating characteristic curve of 0.97 (95% CI: 0.94, 1.00) in the validation set. The upgrade rate of low nuclear grade DCIS at biopsy was 38.8% (50 of 129). Ki-67 positivity (odds ratio, 0.04; 95% CI: 0.0003, 0.43; P = .005) was inversely associated with constant low nuclear grade DCIS. Conclusion The upgrade rate of low nuclear grade ductal carcinoma in situ (DCIS) at biopsy to intermediate to high nuclear grade DCIS at surgery occurred in more than a third of patients; low nuclear grade DCIS at final histopathologic evaluation could be identified if the mass was viewed at US without microcalcifications and had no comedonecrosis at histopathologic evaluation of biopsy. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Rahbar in this issue.
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Affiliation(s)
- Si Eun Lee
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Ga Ram Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Kyunghwa Han
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Eun Hwa Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Eun-Kyung Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Min Jung Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Jung Hyun Yoon
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Vivian Youngjean Park
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Hee Jung Moon
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
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