An improved nomogram including elastography to predict the histological upgrade of ductal carcinoma in situ of the breast.

OBJECTIVE: About 30% of the breast's ductal carcinoma in situ (DCIS) will be histological upstate according to the postoperative pathology. Sentinel lymph node biopsy (SLNB) is currently recommended on most DCIS excision in order to potentially avoid secondary surgery, which is apparently over-treated for most patients with DCIS. Hence, the decision to perform SLNB before DCIS excision remains controversial. The aim of this study is to establish an improved nomogram including elastography for predicting the risk of the histological upgrade of DCIS preoperatively.

PATIENTS AND METHODS: The medical records of 147 patients who were preoperatively diagnosed with DCIS and underwent breast surgery were retrospectively reviewed. They were divided into DCIS group (n=99) and DCIS with invasive components (DCIS-IC) group (n=48) according to the postoperative pathology results. The clinicopathologic and multimode ultrasonic records were analyzed and used to develop the nomogram. The difference in performance between the nomogram with and without acoustic radiation force impulse (ARFI) elastography was compared in this study.

RESULTS: Patients with high-grade lesions (OR = 4.762, p = 0.032), positive human epidemal growth factor receptor 2 (HER-2) expression (OR = 3.560, p = 0.007), comedo type of DCIS (OR: 3.163, p = 0.041), larger lesion size (OR = 3.253, p = 0.002), and higher mean SWV value (SWVmean) (OR: 5.083, p < 0.001) were found to be independent factors associated with the histologic upgrade. The discrimination of the nomogram (0.896), including the 5 independent predictors (ARFI elastography included), was higher than that without ARFI elastography (0.788). It could be utilized to predict the probability of the histologic upgrade of DCIS.

CONCLUSIONS: The developed nomogram incorporating ARFI elastography is expected to predict the risk of the histologic upgrade of DCIS preoperatively and to provide a reference for the decision making for SLNB. It showed improved performance owing to the elastography.