Discrepancy between mammographic and pathological sizing of screen-detected DCIS: Risk factors and impact on ipsilateral recurrence rates.
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All Authors
Kirwan, CC.
Hilton, B.
Clements, K.
Dodwell, D.
Pinder, SE.
Shaaban, A.
Stobart, H.
Wallis, M.
Provenzano, E.
Maxwell, AJ.
LTHT Author
Sharma, Nisha
LTHT Department
Radiology
Breast Screening
Breast Screening
Non Medic
Publication Date
2025
Item Type
Journal Article
Language
Subject
Subject Headings
Abstract
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.
Journal
European Journal of Surgical Oncology