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An Updated Nomogram for Predicting Invasiveness in Preoperative Ductal Carcinoma In Situ of the Breast

Yonsei Medical Journal 2019년 60권 11호 p.1028 ~ 1035
 ( Kim Sang-Hwa ) - Hallym University College of Medicine Hallym University Sacred Heart Hospital Department of Breast and Endocrine Surgery

 ( Kim Ji-Hong ) - Yonsei University College of Medicine Department of Surgery
 ( Park Hyung-Seok ) - Yonsei University College of Medicine Department of Surgery
 ( Kim Ha-Yan ) - Yonsei University College of Medicine Department of Biomedical Systems Informatics
 ( Lee Kwan-Bum ) - Yonsei University College of Medicine Department of Surgery
 ( Lee Jee-A ) - Yonsei University College of Medicine Department of Surgery
 ( Lee Hae-Min ) - Yonsei University College of Medicine Department of Surgery
 ( Kim Jee-Ye ) - Yonsei University College of Medicine Department of Surgery
 ( Kim Seung-Il ) - Yonsei University College of Medicine Department of Surgery
 ( Cho Young-Up ) - Yonsei University College of Medicine Department of Surgery
 ( Park Byeong-Woo ) - Yonsei University College of Medicine Department of Surgery

Abstract


Purpose: To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy.

Materials and Methods: Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous version of the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups according to the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student's t-test, and binary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index and Hosmer-Lemeshow goodness of fit test.

Results: The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperative pathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% of patients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis were operation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographic mass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type, sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model with these variables showed moderate discrimination and was appropriate in the calibration test.

Conclusion: The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.

키워드

Breast neoplasms; prediction; ductal carcinoma in situ; upstaging
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