A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease

James W Jakub, Brittany L. Murphy, Alexandra B. Gonzalez, Amy L. Conners, Tara L. Henrichsen, Santo IV Maimone, Michael G. Keeney, Sarah A. McLaughlin, Barbara A Pockaj, Beiyun Chen, Tashinga Musonza, William S. Harmsen, Judy C Boughey, Tina J Hieken, Elizabeth B Habermann, Harsh N. Shah, Amy C Degnim

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Approximately 8–56% of patients with a core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) will be upstaged to invasive disease at the time of excision. Patients with invasive disease are recommended to undergo axillary nodal staging, most often requiring a second operation. We developed and validated a nomogram to preoperatively predict percentage of risk for upstaging to invasive cancer. Methods: We reviewed 834 cases of DCIS on CNB between January 2004 and October 2014. Multivariable analysis was used to evaluate CNB and imaging factors to develop a nomogram to predict the risk of upstaging from DCIS to invasive cancer. This nomogram was validated with an external dataset of 579 similar patients between November 1998 and September 2016. An area under the receiver operating characteristic curve was constructed to evaluate nomogram discrimination. Results: The rate of upstaging to invasive disease was 118/834 (14.1%). On multivariable analysis, grade on CNB and imaging factors, including mass lesion, multicentric disease, and largest linear dimension, were associated with upstage to invasive disease, and was used to develop a nomogram (c-statistic 0.71). In the external validation dataset, 62/579 (10.7%) patients were upstaged to invasive disease. Our nomogram was validated in this dataset with a c-statistic of 0.71. Conclusion: For patients with a CNB diagnosis of DCIS, our validated nomogram using DCIS grade on biopsy, and imaging factors of mass lesion, multicentric disease, and largest linear dimension, may be used for preoperative assessment of risk of upstaging to invasive disease, allowing patient counseling regarding axillary staging at the time of definitive surgery.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Aug 1 2017

Fingerprint

Nomograms
Carcinoma, Intraductal, Noninfiltrating
Large-Core Needle Biopsy
ROC Curve
Counseling
Neoplasms
Biopsy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease. / Jakub, James W; Murphy, Brittany L.; Gonzalez, Alexandra B.; Conners, Amy L.; Henrichsen, Tara L.; Maimone, Santo IV; Keeney, Michael G.; McLaughlin, Sarah A.; Pockaj, Barbara A; Chen, Beiyun; Musonza, Tashinga; Harmsen, William S.; Boughey, Judy C; Hieken, Tina J; Habermann, Elizabeth B; Shah, Harsh N.; Degnim, Amy C.

In: Annals of Surgical Oncology, 01.08.2017, p. 1-10.

Research output: Contribution to journalArticle

Jakub, James W ; Murphy, Brittany L. ; Gonzalez, Alexandra B. ; Conners, Amy L. ; Henrichsen, Tara L. ; Maimone, Santo IV ; Keeney, Michael G. ; McLaughlin, Sarah A. ; Pockaj, Barbara A ; Chen, Beiyun ; Musonza, Tashinga ; Harmsen, William S. ; Boughey, Judy C ; Hieken, Tina J ; Habermann, Elizabeth B ; Shah, Harsh N. ; Degnim, Amy C. / A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease. In: Annals of Surgical Oncology. 2017 ; pp. 1-10.
@article{0273e192e6cb4e96888086fe3521296d,
title = "A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease",
abstract = "Background: Approximately 8–56{\%} of patients with a core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) will be upstaged to invasive disease at the time of excision. Patients with invasive disease are recommended to undergo axillary nodal staging, most often requiring a second operation. We developed and validated a nomogram to preoperatively predict percentage of risk for upstaging to invasive cancer. Methods: We reviewed 834 cases of DCIS on CNB between January 2004 and October 2014. Multivariable analysis was used to evaluate CNB and imaging factors to develop a nomogram to predict the risk of upstaging from DCIS to invasive cancer. This nomogram was validated with an external dataset of 579 similar patients between November 1998 and September 2016. An area under the receiver operating characteristic curve was constructed to evaluate nomogram discrimination. Results: The rate of upstaging to invasive disease was 118/834 (14.1{\%}). On multivariable analysis, grade on CNB and imaging factors, including mass lesion, multicentric disease, and largest linear dimension, were associated with upstage to invasive disease, and was used to develop a nomogram (c-statistic 0.71). In the external validation dataset, 62/579 (10.7{\%}) patients were upstaged to invasive disease. Our nomogram was validated in this dataset with a c-statistic of 0.71. Conclusion: For patients with a CNB diagnosis of DCIS, our validated nomogram using DCIS grade on biopsy, and imaging factors of mass lesion, multicentric disease, and largest linear dimension, may be used for preoperative assessment of risk of upstaging to invasive disease, allowing patient counseling regarding axillary staging at the time of definitive surgery.",
author = "Jakub, {James W} and Murphy, {Brittany L.} and Gonzalez, {Alexandra B.} and Conners, {Amy L.} and Henrichsen, {Tara L.} and Maimone, {Santo IV} and Keeney, {Michael G.} and McLaughlin, {Sarah A.} and Pockaj, {Barbara A} and Beiyun Chen and Tashinga Musonza and Harmsen, {William S.} and Boughey, {Judy C} and Hieken, {Tina J} and Habermann, {Elizabeth B} and Shah, {Harsh N.} and Degnim, {Amy C}",
year = "2017",
month = "8",
day = "1",
doi = "10.1245/s10434-017-5927-y",
language = "English (US)",
pages = "1--10",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease

AU - Jakub, James W

AU - Murphy, Brittany L.

AU - Gonzalez, Alexandra B.

AU - Conners, Amy L.

AU - Henrichsen, Tara L.

AU - Maimone, Santo IV

AU - Keeney, Michael G.

AU - McLaughlin, Sarah A.

AU - Pockaj, Barbara A

AU - Chen, Beiyun

AU - Musonza, Tashinga

AU - Harmsen, William S.

AU - Boughey, Judy C

AU - Hieken, Tina J

AU - Habermann, Elizabeth B

AU - Shah, Harsh N.

AU - Degnim, Amy C

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: Approximately 8–56% of patients with a core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) will be upstaged to invasive disease at the time of excision. Patients with invasive disease are recommended to undergo axillary nodal staging, most often requiring a second operation. We developed and validated a nomogram to preoperatively predict percentage of risk for upstaging to invasive cancer. Methods: We reviewed 834 cases of DCIS on CNB between January 2004 and October 2014. Multivariable analysis was used to evaluate CNB and imaging factors to develop a nomogram to predict the risk of upstaging from DCIS to invasive cancer. This nomogram was validated with an external dataset of 579 similar patients between November 1998 and September 2016. An area under the receiver operating characteristic curve was constructed to evaluate nomogram discrimination. Results: The rate of upstaging to invasive disease was 118/834 (14.1%). On multivariable analysis, grade on CNB and imaging factors, including mass lesion, multicentric disease, and largest linear dimension, were associated with upstage to invasive disease, and was used to develop a nomogram (c-statistic 0.71). In the external validation dataset, 62/579 (10.7%) patients were upstaged to invasive disease. Our nomogram was validated in this dataset with a c-statistic of 0.71. Conclusion: For patients with a CNB diagnosis of DCIS, our validated nomogram using DCIS grade on biopsy, and imaging factors of mass lesion, multicentric disease, and largest linear dimension, may be used for preoperative assessment of risk of upstaging to invasive disease, allowing patient counseling regarding axillary staging at the time of definitive surgery.

AB - Background: Approximately 8–56% of patients with a core needle biopsy (CNB) diagnosis of ductal carcinoma in situ (DCIS) will be upstaged to invasive disease at the time of excision. Patients with invasive disease are recommended to undergo axillary nodal staging, most often requiring a second operation. We developed and validated a nomogram to preoperatively predict percentage of risk for upstaging to invasive cancer. Methods: We reviewed 834 cases of DCIS on CNB between January 2004 and October 2014. Multivariable analysis was used to evaluate CNB and imaging factors to develop a nomogram to predict the risk of upstaging from DCIS to invasive cancer. This nomogram was validated with an external dataset of 579 similar patients between November 1998 and September 2016. An area under the receiver operating characteristic curve was constructed to evaluate nomogram discrimination. Results: The rate of upstaging to invasive disease was 118/834 (14.1%). On multivariable analysis, grade on CNB and imaging factors, including mass lesion, multicentric disease, and largest linear dimension, were associated with upstage to invasive disease, and was used to develop a nomogram (c-statistic 0.71). In the external validation dataset, 62/579 (10.7%) patients were upstaged to invasive disease. Our nomogram was validated in this dataset with a c-statistic of 0.71. Conclusion: For patients with a CNB diagnosis of DCIS, our validated nomogram using DCIS grade on biopsy, and imaging factors of mass lesion, multicentric disease, and largest linear dimension, may be used for preoperative assessment of risk of upstaging to invasive disease, allowing patient counseling regarding axillary staging at the time of definitive surgery.

UR - http://www.scopus.com/inward/record.url?scp=85026539062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026539062&partnerID=8YFLogxK

U2 - 10.1245/s10434-017-5927-y

DO - 10.1245/s10434-017-5927-y

M3 - Article

C2 - 28766196

AN - SCOPUS:85026539062

SP - 1

EP - 10

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -