Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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A Nomogram Using Imaging Features to Predict Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ

  • Bo Hwa Choi (Department of Radiology, National Cancer Center) ;
  • Soohee Kang (Medical Research Collaborating Center, Seoul National University Hospital) ;
  • Nariya Cho (Department of Radiology, Seoul National University Hospital) ;
  • Soo-Yeon Kim (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine)
  • Received : 2024.01.03
  • Accepted : 2024.08.02
  • Published : 2024.10.01
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Abstract

Objective: To develop a nomogram that integrates clinical-pathologic and imaging variables to predict ipsilateral breast tumor recurrence (IBTR) in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS). Materials and Methods: This retrospective study included consecutive women with DCIS who underwent BCS at two hospitals. Patients who underwent BCS between 2003 and 2016 in one hospital and between 2005 and 2013 in another were classified into development and validation cohorts, respectively. Twelve clinical-pathologic variables (age, family history, initial presentation, nuclear grade, necrosis, margin width, number of excisions, DCIS size, estrogen receptor, progesterone receptor, radiation therapy, and endocrine therapy) and six mammography and ultrasound variables (breast density, detection modality, mammography and ultrasound patterns, morphology and distribution of calcifications) were analyzed. A nomogram for predicting 10-year IBTR probabilities was constructed using the variables associated with IBTR identified from the Cox proportional hazard regression analysis in the development cohort. The performance of the developed nomogram was evaluated in the external validation cohort using a calibration plot and 10-year area under the receiver operating characteristic curve (AUROC) and compared with the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram. Results: The development cohort included 702 women (median age [interquartile range], 50 [44-56] years), of whom 30 (4%) women experienced IBTR. The validation cohort included 182 women (48 [43-54] years), 18 (10%) of whom developed IBTR. A nomogram was constructed using three clinical-pathologic variables (age, margin, and use of adjuvant radiation therapy) and two mammographic variables (breast density and calcification morphology). The nomogram was appropriately calibrated and demonstrated a comparable 10-year AUROC to the MSKCC nomogram (0.73 vs. 0.66, P = 0.534) in the validation cohort. Conclusion: Our nomogram provided individualized risk estimates for women with DCIS treated with BCS, demonstrating a discriminative ability comparable to that of the MSKCC nomogram.

Keywords

Acknowledgement

We would like to thank Editage (www.editage.co.kr) for English language editing.

References

  1. Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal carcinoma in situ: state-of-the-art review. Radiology 2022;302:246-255
  2. Ryser MD, Hendrix LH, Worni M, Liu Y, Hyslop T, Hwang ES. Incidence of ductal carcinoma in situ in the United States, 2000-2014. Cancer Epidemiol Biomarkers Prev 2019;28:1316-1323
  3. Elshof LE, Schmidt MK, Rutgers EJT, van Leeuwen FE, Wesseling J, Schaapveld M. Cause-specific mortality in apopulation-based cohort of 9799 women treated for ductal carcinoma in situ. Ann Surg 2018;267:952-958
  4. Rudloff U, Jacks LM, Goldberg JI, Wynveen CA, Brogi E, Patil S, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol 2010;28:3762-3769
  5. Yi M, Meric-Bernstam F, Kuerer HM, Mittendorf EA, Bedrosian I, Lucci A, et al. Evaluation of a breast cancer nomogram for predicting risk of ipsilateral breast tumor recurrences in patients with ductal carcinoma in situ after local excision. J Clin Oncol 2012;30:600-607
  6. Grimm LJ, Shelley Hwang E. Active surveillance for DCIS: the importance of selection criteria and monitoring. Ann Surg Oncol 2016;23:4134-4136
  7. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer 1996;77:2267-2274
  8. Solin LJ, Gray R, Baehner FL, Butler SM, Hughes LL, Yoshizawa C, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 2013;105:701-710
  9. Silverstein MJ. The University of Southern California/Van Nuys Prognostic Index for ductal carcinoma in situ of the breast. Am J Surg 2003;186:337-343
  10. Silverstein MJ, Lagios MD. Choosing treatment for patients with ductal carcinoma in situ: fine tuning the University of Southern California/Van Nuys Prognostic Index. J Natl Cancer Inst Monogr 2010;2010:193-196
  11. Sweldens C, Peeters S, van Limbergen E, Janssen H, Laenen A, Patil S, et al. Local relapse after breast-conserving therapy for ductal carcinoma in situ: a European single-center experience and external validation of the Memorial Sloan-Kettering Cancer Center DCIS nomogram. Cancer J 2014;20:1-7
  12. Collins LC, Achacoso N, Haque R, Nekhlyudov L, Quesenberry CP Jr, Schnitt SJ, et al. Risk prediction for local breast cancer recurrence among women with DCIS treated in a community practice: a nested, case-control study. Ann Surg Oncol 2015;22(Suppl 3):S502-S508
  13. Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, et al. A population-based validation study of the DCIS score predicting recurrence risk in individuals treated by breast-conserving surgery alone. Breast Cancer Res Treat 2015;152:389-398
  14. van Seijen M, Joz'wiak K, Pinder SE, Hall A, Krishnamurthy S, Thomas JS, et al. Variability in grading of ductal carcinoma in situ among an international group of pathologists. J Pathol Clin Res 2021;7:233-242
  15. Groen EJ, Hudecek J, Mulder L, van Seijen M, Almekinders MM, Alexov S, et al. Prognostic value of histopathological DCIS features in a large-scale international interrater reliability study. Breast Cancer Res Treat 2020;183:759-770
  16. Solin LJ. Management of ductal carcinoma in situ (DCIS) of the breast: present approaches and future directions. Curr Oncol Rep 2019;21:33
  17. Scoggins ME, Fox PS, Kuerer HM, Rauch GM, Benveniste AP, Park YM, et al. Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol 2015;204:878-888
  18. Lamb LR, Mercaldo S, Kim G, Hovis K, Oseni TO, Bahl M. Predicting ipsilateral recurrence in women treated for ductal carcinoma in situ using machine learning and multivariable logistic regression models. Clin Imaging 2022;92:94-100
  19. D'Orsi C, Sickles E, Mendelson E, Morris E. ACR BI-RADS atlas, breast imaging reporting and data system. 5th ed. Reston: American College of Radiology, 2013
  20. Uematsu T. Non-mass-like lesions on breast ultrasonography: a systematic review. Breast Cancer 2012;19:295-301
  21. Lee SE, Kim GR, Han K, Kim EH, Kim EK, Kim MJ, et al. US, mammography, and histopathologic evaluation to identify low nuclear grade ductal carcinoma in situ. Radiology 2022;303:276-284
  22. Gastounioti A, Kasi CD, Scott CG, Brandt KR, Jensen MR, Hruska CB, et al. Evaluation of LIBRA software for fully automated mammographic density assessment in breast cancer risk prediction. Radiology 2020;296:24-31
  23. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174
  24. Williams BA, Mandrekar JN, Mandrekar SJ, Cha SS, Furth AF. Finding optimal cutpoints for continuous covariates with binary and time-to-event outcomes. Rochester: Mayo Foundation, 2006
  25. Habel LA, Dignam JJ, Land SR, Salane M, Capra AM, Julian TB. Mammographic density and breast cancer after ductal carcinoma in situ. J Natl Cancer Inst 2004;96:1467-1472
  26. Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007;356:227-236
  27. Rauch GM, Hobbs BP, Kuerer HM, Scoggins ME, Benveniste AP, Park YM, et al. Microcalcifications in 1657 patients with pure ductal carcinoma in situ of the breast: correlation with clinical, histopathologic, biologic features, and local recurrence. Ann Surg Oncol 2016;23:482-489
  28. Woodard GA, Price ER. Qualitative radiogenomics: association between BI-RADS calcification descriptors and recurrence risk as assessed by the oncotype DX ductal carcinoma in situ score. AJR Am J Roentgenol 2019;212:919-924
  29. Holmberg L, Wong YN, Tabar L, Ringberg A, Karlsson P, Arnesson LG, et al. Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study. Br J Cancer 2013;108:812-819
  30. Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast cancer screening for women at higher-than-average risk: updated recommendations from the ACR. J Am Coll Radiol 2023;20:902-914
  31. Vicini FA, Recht A. Age at diagnosis and outcome for women with ductal carcinoma-in-situ of the breast: a critical review of the literature. J Clin Oncol 2002;20:2736-2744
  32. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol 2016;34:4040-4046
  33. McCormick B, Winter KA, Woodward W, Kuerer HM, Sneige N, Rakovitch E, et al. Randomized phase III trial evaluating radiation following surgical excision for good-risk ductal carcinoma in situ: long-term report from NRG oncology/RTOG 9804. J Clin Oncol 2021;39:3574-3582
  34. Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853-a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 2006;24:3381-3387
  35. Hong YK, McMasters KM, Egger ME, Ajkay N. Ductal carcinoma in situ current trends, controversies, and review of literature. Am J Surg 2018;216:998-1003
  36. Kuhl CK. Let us move out of plato's cave: the greater reality of DCIS. Radiology 2021;301:78-80