Can upstaging of ductal carcinoma in situ be predicted at biopsy by histologic and mammographic features?

Bibo Shi, Lars J. Grimm, Maciej A. Mazurowski, Jeffrey R. Marks, Lorraine M. King, Carlo Maley, E. Shelley Hwang, Joseph Y. Lo

Research output: Chapter in Book/Report/Conference proceedingConference contribution


Reducing the overdiagnosis and overtreatment associated with ductal carcinoma in situ (DCIS) requires accurate prediction of the invasive potential at cancer screening. In this work, we investigated the utility of pre-operative histologic and mammographic features to predict upstaging of DCIS. The goal was to provide intentionally conservative baseline performance using readily available data from radiologists and pathologists and only linear models. We conducted a retrospective analysis on 99 patients with DCIS. Of those 25 were upstaged to invasive cancer at the time of definitive surgery. Pre-operative factors including both the histologic features extracted from stereotactic core needle biopsy (SCNB) reports and the mammographic features annotated by an expert breast radiologist were investigated with statistical analysis. Furthermore, we built classification models based on those features in an attempt to predict the presence of an occult invasive component in DCIS, with generalization performance assessed by receiver operating characteristic (ROC) curve analysis. Histologic features including nuclear grade and DCIS subtype did not show statistically significant differences between cases with pure DCIS and with DCIS plus invasive disease. However, three mammographic features, i.e., the major axis length of DCIS lesion, the BI-RADS level of suspicion, and radiologist's assessment did achieve the statistical significance. Using those three statistically significant features as input, a linear discriminant model was able to distinguish patients with DCIS plus invasive disease from those with pure DCIS, with AUC-ROC equal to 0.62. Overall, mammograms used for breast screening contain useful information that can be perceived by radiologists and help predict occult invasive components in DCIS.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2017
Subtitle of host publicationComputer-Aided Diagnosis
EditorsNicholas A. Petrick, Samuel G. Armato
ISBN (Electronic)9781510607132
StatePublished - 2017
EventMedical Imaging 2017: Computer-Aided Diagnosis - Orlando, United States
Duration: Feb 13 2017Feb 16 2017

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


OtherMedical Imaging 2017: Computer-Aided Diagnosis
Country/TerritoryUnited States


  • Breast cancer
  • Digital mammogram
  • Ductal carcinoma in situ
  • Microcalcification
  • Statistical analysis

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Atomic and Molecular Physics, and Optics
  • Biomaterials
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Can upstaging of ductal carcinoma in situ be predicted at biopsy by histologic and mammographic features?'. Together they form a unique fingerprint.

Cite this