- Design
- Retrospective cohort with multivariable model development
- Population
- 258 biopsy-diagnosed pure DCIS
- Primary outcome
- Upstaging to (micro-)invasive carcinoma
- Effect
- Solid architecture (P = .001) and size over 20 mm (P = .025) predicted upstaging; model 2 low risk in 55% of ER+/HER2- mastectomies
Sentinel node biopsy is still recommended for DCIS treated by mastectomy because invasive cancer may be found in the specimen. This retrospective study of 258 biopsy-diagnosed pure DCIS looked for features that predict upstaging.
Solid architecture and radiological size over 20 mm were independently associated with upstaging. Two flowcharts combined surgery type, ER/HER2 status and upstaging risk. The second — high risk if solid architecture or absent histological calcifications — classed 32 of 58 (55%) ER-positive HER2-negative DCIS treated by mastectomy as low risk. In each model, only one low-risk patient was upstaged to invasive ER-positive HER2-negative cancer, and none had a positive sentinel node.
For pathologists, the practical point is that architecture and calcification status on the core biopsy carry prognostic weight and should be reported clearly. The authors say the flowchart needs retrospective validation and then prospective trials before use.
- Report DCIS architecture, including solid pattern, on every core biopsy
- Record whether calcifications are present in the sampled DCIS
- Include ER and HER2 status on DCIS cores where local practice allows
- Do not use this flowchart to omit sentinel node biopsy outside a validation study
Why it matters
It gives core-biopsy morphology a possible role in sparing axillary surgery.
Don't overread it
The model is derived, not validated, and rests on a single upstaging event in each low-risk group.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for pathology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free