How to predict upstaging to invasive breast carcinoma after a biopsy diagnosis of pure ductal carcinoma in situ of the breast?
(2025) 15th Joint Meeting of the BDIAP and the Pathological Society — Location: (Belgium) Ghent (24.June.2025)
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- (en) Purpose of the study Around 20% of patients with biopsy-diagnosed pure ductal carcinoma in situ (DCIS) present an invasive tumour in the subsequent resection. We aim to find reliable prognostic markers to predict upstaging to invasive breast cancer (IBC). Methods Archived biopsy slides of 272 patients with pure biopsy-diagnosed DCIS were assessed. Nuclear atypia, DCIS architecture, necrosis, calcifications, periductal myxoid stroma, lobular cancerization, and HER2 were scored as categorial variables. Tumour-infiltrating lymphocytes (TILs), oestrogen receptor (ER), and progesterone receptor (PR) were scored as continuous variables. Statistical analysis included Chi-square tests for categorical data, Mann-Whitney tests for continuous data, univariate and multivariate logistic regression. Summary of results Fifty-four of 272 women (19.9%) were upstaged to IBC after surgery. In univariate analysis, solid architecture and lack of calcifications are significantly associated with upstaging (p = 0.008 and p = 0.02). Multivariate analyses show that solid architecture and lack of calcifications are independent predictors (p = 0.004 and p = 0.001). Some parameters show a trend towards upstaging without being statistically significant: high TILs (p = 0.063) and periductal myxoid stroma (p = 0.084). Cribriform architecture, ER, PR, HER2, nuclear grade, solid or micro-papillary architecture and lobular cancerisation are not statistically significantly associated with upstaging (p > 0.05). Conclusions We identified the absence of calcifications and solid DCIS architecture as significant predictors for upstaging to IBC. The present complementary immunohistochemistry for ER and PR realized in clinical practice does not help to distinguish DCIS with synchronous IBC from pure DCIS. We currently analyse the expression of 12 different proteins by multiplex immunofluorescence immunohistochemistry, aiming to explore their expression in the extracellular matrix, the neoplastic cells and TILs.
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Riggi, J., Galant, C., Benhaddi, N., Vernaeve, H., Vassilieff, M., Fellah, L., Leconte, I., Gerday, A., Coyette, M., Hammer, J., Berlière, M., & Van Bockstal, M. (2025). How to predict upstaging to invasive breast carcinoma after a biopsy diagnosis of pure ductal carcinoma in situ of the breast? Journal of Pathology, 267(Suppl 2), S6. https://hdl.handle.net/2078.5/277257 (Original work published 2025)