Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus

Abstract Background and Objectives To investigate the preoperative factors associated with upstage to invasive cancer in patients with core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) by ultrasound guidance alone. Methods Between 2000 and 2007, 201 patients with DCIS diagnosed at 11‐ or 14‐gauge CNB by ultrasound guidance alone were examined. Preoperative factors were all analyzed to correlate with the presence of invasive cancer after definitive resection. The Pearson chi‐square test and stratified analysis with the Mantel‐Haenszel chi‐squire test were used to assess the association between the preoperative factors and upstage to invasive cancer. Results Compared with the overall underestimation rate (84 of 201, 41.8%), 47 (60.3%) of 78 patients with abnormal breast palpation, 46 (55.4%) of 83 patients with mammographic finding of a mass lesion, and 38 (67.9%) of 56 patients with a sonographic lesion size >20 mm had invasive cancer components on the final pathology review (Odds ratio [OR] = 2.45; P = 0.04, OR = 3.66; P = 0.002, and OR = 4.13; P = 0.002 respectively). Conclusion A sonographic lesion size >20 mm can be used as another guideline for surgeons to consider sentinel lymph node biopsy in patients with DCIS diagnosed by a sonographically guided CNB. J. Surg. Oncol. 2008;98:15–20. © 2008 Wiley‐Liss, Inc.