Predicting Lymph Node Metastases in Patients with Biopsy-Proven Ductal Carcinoma In Situ of the Breast: Development and Validation of the DCIS-met Model

Claudia J.C. Meurs, Joost van Rosmalen, Marian B.E. Menke-Pluijmers, Sabine Siesling, Pieter J. Westenend*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
16 Downloads (Pure)


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 languageEnglish
Pages (from-to)2142-2151
Number of pages10
JournalAnnals of Surgical Oncology
Issue number4
Early online date10 Dec 2022
Publication statusPublished - 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).


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