An Updated Nomogram for Predicting Invasiveness in Preoperative Ductal Carcinoma In Situ of the Breast
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Purpose: To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy. Materials and Methods: Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous versionof the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups accordingto the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student’s t-test, andbinary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index andHosmer—Lemeshow goodness of fit test. Results: The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperativepathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% ofpatients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis wereoperation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographicmass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type,sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model withthese variables showed moderate discrimination and was appropriate in the calibration test. Conclusion: The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.
Abstract
Purpose: To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy. Materials and Methods: Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous versionof the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups accordingto the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student’s t-test, andbinary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index andHosmer—Lemeshow goodness of fit test. Results: The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperativepathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% ofpatients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis wereoperation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographicmass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type,sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model withthese variables showed moderate discrimination and was appropriate in the calibration test. Conclusion: The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.
참고문헌 (18)
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