Non-histopathological parameters associated with upgrade of breast tumours yielding a core biopsy report of histological grade 2 ductal no special type to grade 3 on excision

Hassen Ahmeidat (Lead / Corresponding author), Colin Purdie, Lee Jordan, Dawn Fleming, Jean McCullough, Andrew Evans

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    Abstract

    Purpose: The aim of the study was to identify clinical, radiological and immuno-histochemical factors that may help predict upgrade of invasive ductal cancers of no special type (IDC-NST) with a core biopsy grade of 2 to grade 3 on final histology.

    Methods: A prospectively maintained database of ultrasound visible solid masses was used to identify lesions yielding a core biopsy result of IDC-NST grade 2 who underwent immediate surgery yielding a grade 2 or grade 3 tumour. Associations were sought between the source of patient (screening/symptomatic), core biopsy receptor status and imaging findings and the grade of the excision specimen tumour. Statistical analysis, which included the chi-squared test, ROC curves and Cox regression analysis, was used to compare upgrade vs no upgrade for each factor.

    Results: 463 IDC-NST breast cancers of core biopsy grade 2 gave 344 grade 2 and 119 grade 3 tumours at excision. Factors significantly associated with upgrade were large ultrasound (US) size, hyperechogencity, stiffness at shearwave elastography (SWE), calcification on mammography and oestrogen receptor (ER) and progesterone receptor (PR) negativity. Patient source, Human epidermal growth factor receptor 2 (HER-2) status, ultrasound (US) distal effect and mammographic spiculation were not significantly associated with chance of upgrade. On multivariate analysis, only US size maintained statistical significance.

    Conclusion: Oncologists and surgeons should be aware that lesions with a core biopsy diagnosis of grade 2 IDC-NST measuring over 15 mm on US have a 37% chance of being grade 3 on excision and this should be considered when deciding pre-operative management.

    Original languageEnglish
    Pages (from-to)1720-1724
    Number of pages5
    JournalEuropean Journal of Surgical Oncology
    Volume44
    Issue number11
    Early online date7 Aug 2018
    DOIs
    Publication statusPublished - 1 Nov 2018

    Fingerprint

    Breast Neoplasms
    Biopsy
    Neoplasms
    Elasticity Imaging Techniques
    Progesterone Receptors
    Mammography
    ROC Curve
    Estrogen Receptors
    Histology
    Multivariate Analysis
    Regression Analysis
    Databases

    Keywords

    • Clinical features
    • Histological grade
    • Invasive carcinoma of no special type
    • Neoadjuvant chemotherapy
    • Radiological features
    • Receptor status
    • Upgrade rate

    Cite this

    @article{1df3e071c5af4d0692eb36c81e6f5deb,
    title = "Non-histopathological parameters associated with upgrade of breast tumours yielding a core biopsy report of histological grade 2 ductal no special type to grade 3 on excision",
    abstract = "Purpose: The aim of the study was to identify clinical, radiological and immuno-histochemical factors that may help predict upgrade of invasive ductal cancers of no special type (IDC-NST) with a core biopsy grade of 2 to grade 3 on final histology.Methods: A prospectively maintained database of ultrasound visible solid masses was used to identify lesions yielding a core biopsy result of IDC-NST grade 2 who underwent immediate surgery yielding a grade 2 or grade 3 tumour. Associations were sought between the source of patient (screening/symptomatic), core biopsy receptor status and imaging findings and the grade of the excision specimen tumour. Statistical analysis, which included the chi-squared test, ROC curves and Cox regression analysis, was used to compare upgrade vs no upgrade for each factor.Results: 463 IDC-NST breast cancers of core biopsy grade 2 gave 344 grade 2 and 119 grade 3 tumours at excision. Factors significantly associated with upgrade were large ultrasound (US) size, hyperechogencity, stiffness at shearwave elastography (SWE), calcification on mammography and oestrogen receptor (ER) and progesterone receptor (PR) negativity. Patient source, Human epidermal growth factor receptor 2 (HER-2) status, ultrasound (US) distal effect and mammographic spiculation were not significantly associated with chance of upgrade. On multivariate analysis, only US size maintained statistical significance.Conclusion: Oncologists and surgeons should be aware that lesions with a core biopsy diagnosis of grade 2 IDC-NST measuring over 15 mm on US have a 37{\%} chance of being grade 3 on excision and this should be considered when deciding pre-operative management.",
    keywords = "Clinical features, Histological grade, Invasive carcinoma of no special type, Neoadjuvant chemotherapy, Radiological features, Receptor status, Upgrade rate",
    author = "Hassen Ahmeidat and Colin Purdie and Lee Jordan and Dawn Fleming and Jean McCullough and Andrew Evans",
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    Non-histopathological parameters associated with upgrade of breast tumours yielding a core biopsy report of histological grade 2 ductal no special type to grade 3 on excision. / Ahmeidat, Hassen (Lead / Corresponding author); Purdie, Colin; Jordan, Lee; Fleming, Dawn; McCullough, Jean; Evans, Andrew.

    In: European Journal of Surgical Oncology, Vol. 44, No. 11, 01.11.2018, p. 1720-1724.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Non-histopathological parameters associated with upgrade of breast tumours yielding a core biopsy report of histological grade 2 ductal no special type to grade 3 on excision

    AU - Ahmeidat, Hassen

    AU - Purdie, Colin

    AU - Jordan, Lee

    AU - Fleming, Dawn

    AU - McCullough, Jean

    AU - Evans, Andrew

    N1 - Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

    PY - 2018/11/1

    Y1 - 2018/11/1

    N2 - Purpose: The aim of the study was to identify clinical, radiological and immuno-histochemical factors that may help predict upgrade of invasive ductal cancers of no special type (IDC-NST) with a core biopsy grade of 2 to grade 3 on final histology.Methods: A prospectively maintained database of ultrasound visible solid masses was used to identify lesions yielding a core biopsy result of IDC-NST grade 2 who underwent immediate surgery yielding a grade 2 or grade 3 tumour. Associations were sought between the source of patient (screening/symptomatic), core biopsy receptor status and imaging findings and the grade of the excision specimen tumour. Statistical analysis, which included the chi-squared test, ROC curves and Cox regression analysis, was used to compare upgrade vs no upgrade for each factor.Results: 463 IDC-NST breast cancers of core biopsy grade 2 gave 344 grade 2 and 119 grade 3 tumours at excision. Factors significantly associated with upgrade were large ultrasound (US) size, hyperechogencity, stiffness at shearwave elastography (SWE), calcification on mammography and oestrogen receptor (ER) and progesterone receptor (PR) negativity. Patient source, Human epidermal growth factor receptor 2 (HER-2) status, ultrasound (US) distal effect and mammographic spiculation were not significantly associated with chance of upgrade. On multivariate analysis, only US size maintained statistical significance.Conclusion: Oncologists and surgeons should be aware that lesions with a core biopsy diagnosis of grade 2 IDC-NST measuring over 15 mm on US have a 37% chance of being grade 3 on excision and this should be considered when deciding pre-operative management.

    AB - Purpose: The aim of the study was to identify clinical, radiological and immuno-histochemical factors that may help predict upgrade of invasive ductal cancers of no special type (IDC-NST) with a core biopsy grade of 2 to grade 3 on final histology.Methods: A prospectively maintained database of ultrasound visible solid masses was used to identify lesions yielding a core biopsy result of IDC-NST grade 2 who underwent immediate surgery yielding a grade 2 or grade 3 tumour. Associations were sought between the source of patient (screening/symptomatic), core biopsy receptor status and imaging findings and the grade of the excision specimen tumour. Statistical analysis, which included the chi-squared test, ROC curves and Cox regression analysis, was used to compare upgrade vs no upgrade for each factor.Results: 463 IDC-NST breast cancers of core biopsy grade 2 gave 344 grade 2 and 119 grade 3 tumours at excision. Factors significantly associated with upgrade were large ultrasound (US) size, hyperechogencity, stiffness at shearwave elastography (SWE), calcification on mammography and oestrogen receptor (ER) and progesterone receptor (PR) negativity. Patient source, Human epidermal growth factor receptor 2 (HER-2) status, ultrasound (US) distal effect and mammographic spiculation were not significantly associated with chance of upgrade. On multivariate analysis, only US size maintained statistical significance.Conclusion: Oncologists and surgeons should be aware that lesions with a core biopsy diagnosis of grade 2 IDC-NST measuring over 15 mm on US have a 37% chance of being grade 3 on excision and this should be considered when deciding pre-operative management.

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    KW - Neoadjuvant chemotherapy

    KW - Radiological features

    KW - Receptor status

    KW - Upgrade rate

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