Pathological Underestimation of Core Needle Biopsy Risks in Ductal Carcinoma In Situ Breast Cancer Diagnosis: a Predictive Nomogram

Abstract Purpose The study aimed to investigate the predictors of pathological underestimation (PU) in patients with DCIS diagnosed preoperatively by ultrasonocentesis and to create a nomogram to predict the risk of PU, providing a risk assessment tool that can assist clinicians in their surgical decision-making. Methods This retrospective study collected data of 309 patients with DCIS from the First Hospital of China Medical University between June 2012 and June 2022. Univariate and multivariate analyses were used in this training cohort to select independent risk factors that affect the PU risks in DCIS patients diagnosed by ultrasound-guided hollow needle aspiration biopsy (US-CNB), and a nomogram was established. The internal validation method was used as the validation cohort to verify the model. Results While IBC patients showed significant BI RADS mass differences by US (P = 0.029), linear/segmental calcification (P < 0.001), microinvasion (P = 0.002), and menstruation showed critical differences (P = 0.057). When we compared lymph node metastasis (LNM) patients with non-LNM patients, the former group showed significant abnormal lymph node differences by US (P < 0.001), ER (P = 0.003), PR (P = 0.022), Ki-67 (P = 0.005), PDW (P = 0.0039), and NLR (P = 0.016). In the IBC and LNM nomogram, the C-statistic was 0.814 (95% CI: 0.766–0.863) and 0.780 (95% CI: 0.642–0.917) respectively. The calibration curve showed that the nomogram was well calibrated, and the mean absolute calibration error was 0.029 and 0.019 respectively. Conclusions We created a nomogram predicting the likelihood of PU in DCIS patients diagnosed with US-CNB. Risk stratification with this nomogram could develop standardized practices to optimize DCIS patient management.