Discrepancy between mammographic and pathological sizing of screen-detected DCIS: Risk factors and impact on ipsilateral recurrence rates.

BACKGROUND

Discrepancy between mammographic and pathological sizing of DCIS can lead to surgical overtreatment, with poorer cosmesis or unnecessary mastectomy, or undertreatment and recurrence.

METHODS

Within the UK Sloane Project prospective cohort study of screen-detected DCIS (2003-2012), we investigated factors associated with 'pathology larger (PL)' (pathological larger than mammographic size) or 'mammogram larger (ML)' (mammographic larger than pathologic size), size discrepancy and the impact on ipsilateral recurrence.

RESULTS

Among 9937 patients (mean age 60; range 46-87), mammographic size remained constant at median 19 mm (IQR 10-35)mm whilst pathological size increased from 16(10-28)mm to 20(10-33)mm (p = 0.001)over the study. The mammographic and pathological size discrepancy decreased from 3.4 mm to 0.2 mm (p < 0.05). In patients undergoing BCS, size discrepancy of ≥5 mm was associated with increased 5-year ipsilateral recurrence if lesions were PL (odds ratio(OR) 1.37 (C.I. 1.03-1.82, p = 0.03) and if lesions were ML (OR 1.4 (C.I. 1.10-1.86, p = 0.008), compared to <5 mm discrepancy. Factors associated with PL by ≥ 5 mm were high grade (OR 1.9 [95 % CI 1.5-2.4, p < 0.001]) and mastectomy (OR 4.4 [C.I. 3.8-5.1, p < 0.001]) and for ML ≥ 5 mm was larger mammographic tumour size (>40 mm; OR 115.7 [C.I. 82.3-162.6], p < 0.001]).

CONCLUSION

Mammographic-pathological size discrepancy is associated with higher recurrence following BCS for DCIS.