Kotryna Kvitkovskaja1, Monika Sudeikytė1, Algirdas Boguševičius2
1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine.
2Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Department of Breast Surgery.
Introduction: ductal carcinoma in situ (DCIS) is a type of non – invasive breast cancer (1). It can be diagnosed with a core biopsy though the method is known to miss 10 % of the cases of invasive carcinoma (IC), and for that reason operative treatment is indicated for all patients (2–4). The need of sentinel lymph node biopsy (SLNB) depends on factors of invasiveness, which are poorly defined (2,5–8). Aim: to establish the incidence of IC in preoperatively diagnosed DCIS and evaluate the factors of invasiveness. Materials and methods: medical records of 66 women with preoperatively diagnosed DCIS were analyzed. Patients were assigned to either a DCIS group or an IC group based on surgical specimen histology. Clinical, radiological and pathological factors of invasiveness were compared between the groups. The incidence of SLNB and its necessity based on final histological evaluation was determined. Results: there was a significantly higher incidence of IC (28.6 %) in MRI compared to DCIS (0 %) when the tumor was 40 mm and larger, p = 0.037. Suspicious lymph nodes in radiological assessment were found in 57.1 % of all IC cases, p < 0.001. High grade nuclear polymorphism was significantly higher in the IC group and reached 71.4 % compared to the 44.7 % of cases found in the DCIS group, p = 0.049. Conclusions: predictive factors for invasiveness are the size of the tumor being ≥ 40 mm on MRI, suspicious lymph nodes on radiological assessment and high grade nuclear polymorphism.
Keywords: ductal carcinoma in situ (DCIS), invasive breast cancer (IC), predictive factors, factors of invasiveness, sentinel lymph node biopsy (SLNB).