Abstract
Purpose: In patients with a biopsy-proven ductal carcinoma in situ (DCIS), axillary staging is frequently performed, but in hindsight often turns out to be superfluous. The aim of this observational study was to develop a prediction model for risk of lymph node metastasis in patients with a biopsy-proven DCIS. Methods: Data were received from the Dutch Pathology Databank and the Netherlands Cancer Registry. The population-based cohort consisted of all biopsy-proven DCIS patients diagnosed in the Netherlands in 2011 and 2012. The prediction model was evaluated with the area under the curve (AUC) of the receiver operating characteristic, and a calibration plot and a decision curve analysis and was validated in a Dutch cohort of patients diagnosed in the period 2016–2019. Results: Of 2892 biopsy-proven DCIS patients, 127 had metastasis (4.4%). Risk factors were younger age (OR = 0.97, 95% CI 0.95–0.99), DCIS not detected by screening (OR = 1.55, 95% CI 1.01–2.38), suspected invasive component at biopsy (OR = 1.86, 95% CI 1.01–3.41), palpable tumour (OR = 2.06, 95% CI 1.34–3.18), BI-RADS score 5 (OR = 2.41, 95% CI 1.53–3.78), intermediate-grade DCIS (OR = 3.01, 95% CI 1.27–7.15) and high-grade DCIS (OR = 3.20, 95% CI 1.36–7.54). For 24% (n = 708) of the patients, the predicted risk of lymph node metastasis was above 5%. Based on the decision curve analysis, the model had a net benefit for a predicted risk below 25%. The AUC was 0.745. Of the 2269 patients in the validation cohort, 53 (2.2%) had metastasis and the AUC was 0.741. Conclusions: This DCIS-met model can support clinical decisions on axillary staging in patients with biopsy-proven DCIS.
Original language | English |
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Pages (from-to) | 2142-2151 |
Number of pages | 10 |
Journal | Annals of Surgical Oncology |
Volume | 30 |
Issue number | 4 |
Early online date | 10 Dec 2022 |
DOIs | |
Publication status | Published - Apr 2023 |
Bibliographical note
Funding Information:The authors thank the Netherlands Comprehensive Cancer Organisation and PALGA, Dutch Nationwide Pathology Databank, for providing the databases of respectively the Netherlands Cancer Registry (NCR) and the Dutch Pathology Registry.
Funding Information:
This work was supported by the Dutch Cancer Society (KWF), grant SLP2015-7769, and by the Stichting Vriendenfonds Albert Schweitzer ziekenhuis; support for the submitted work for the author C. Meurs.
Publisher Copyright:
© 2022, The Author(s).