ArticleGland surgery2025
Predictors and nomogram for upstaging to invasive breast carcinoma in ductal carcinoma
Article in Gland surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Development of a Nomogram-Based Clinical Estimation Model for Pathological Upstaging in Patients With Preoperative Ductal Carcinoma In Situ.The Kaohsiung journal of medical sciences · 2026Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Ductal carcinoma in situ (DCIS) cases diagnosed by ultrasound-guided core needle biopsy (US-CNB) carry a risk of postoperative upstaging to invasive breast carcinoma, complicating clinical management. This study aimed to investigate clinicopathological and ultrasound (US) predictors for postoperative upstaging and to develop a nomogram for individualized risk prediction. Methods: A total of 240 patients with 246 DCIS lesions diagnosed by US-CNB were enrolled in this retrospective study from May 2013 to January 2025. Clinicopathological and US features were compared using the Student's Results: Among all the lesions, 161 (65.4%) were diagnosed as pure DCIS, while 85 (34.6%) were upstaged to DCIS-IC, including 37 (15.0% of total) with microinvasive carcinoma. Age [per 1-year increase, odds ratio (OR) =1.04; 95% confidence interval (CI): 1.01-1.06; P=0.01], Ki-67 >20% (OR =2.56; 95% CI: 1.35-4.86; P=0.004), and suspicious axillary lymph node (ALN) on US (OR =3.00; 95% CI: 1.07-8.45; P=0.04) were independent predictors of postoperative upstaging to DCIS-IC. The nomogram showed moderate discrimination with an apparent area under the curve (AUC) of 0.72 (95% CI: 0.65-0.78), which was internally validated as 0.70 (95% CI: 0.66-0.72) using 1,000 bootstrap replicates. It demonstrated good calibration (H-L test, P=0.86). The DCA showed that the nomogram provided net benefit across a threshold probability range of 20% to 88% compared to default strategies. Although larger tumor size (>1 cm; P=0.02) and non-circumscribed mass margins (P=0.03) were associated with upstaging in univariate analysis, they were not retained as independent predictors in the multivariate model. Conclusions: The nomogram incorporating age, Ki-67, and suspicious ALN on US effectively predicts DCIS upstaging risk in cases diagnosed by US-CNB and may assist in clinical decision-making. US characteristics (size >1 cm, non-circumscribed mass margins) may provide supplementary information but require further validation.
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