Noncalcified Ductal Carcinoma In Situ (DCIS): Rate and Predictors of Upgrade to Invasive Carcinoma

From the Massachusetts General Hospital/Department of Radiology, 55 Fruit Street, WAC 240, Boston, MA 02114 (L.R.L., G.K., M.B.); Massachusetts General Hospital/Department of Surgery, Boston, MA (T.O.O.). Received January 27, 2020; revised February 11, 2020; accepted February 14, 2020. AddressRationale and Objectives: To determine the upgrade rate of noncalcified ductal carcinoma in situ (DCIS) and features that are associated with risk of upgrade to invasive disease at surgery. Materials and Methods: A retrospective review was conducted of consecutive women who were diagnosed with noncalcified DCIS from January 2007 to December 2016. Patient demographics, imaging findings, biopsy pathology results, and surgical outcomes were reviewed. The unpaired t test, chi-square test, and Fisher?s exact test were used to compare features between the cases of DCIS that did and did not upgrade to invasive carcinoma at surgery. Results: Over a 10-year period, 78 women (mean age 62 years, range 30-88 years) were diagnosed with noncalcified DCIS. Two-thirds (67.9%, 53/78) of cases were detected on screening mammography, and 15.4% (12/78) of diagnoses were made after presentation with an area of palpable concern. The most common mammographic presentations of noncalcified DCIS were mass (51.3%, 40/78) and asymmetry (30.8%, 24/78). Seventeen cases (21.8%, 17/78) were upgraded to invasive ductal carcinoma (IDC) at surgery. Features associated with upgrade risk included older patient age (68.1 versus 60.3 years, OR 1.08, p < 0.01) and family history of breast cancer in a first-degree relative (41.2% [7/17] versus 16.4% [10/61], OR 3.57, p = 0.03). Conclusion: In our study cohort, the upgrade rate of noncalcified DCIS to IDC at surgery is 21.8%. Upgrade risk is associated with older patient age and family history of breast cancer in a first-degree relative.