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Lookup NU author(s): Dr Simon Lowes
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© 2025Background: 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.
Author(s): Kirwan CC, Hilton B, Clements K, Dodwell D, Pinder SE, Shaaban A, Stobart H, Wallis M, Provenzano E, Maxwell AJ, Sharma N, Sawyer E, Lowes S, Kearins O, Cutress RI, Mylvaganam S, Thompson A
Publication type: Article
Publication status: Published
Journal: European Journal of Surgical Oncology
Year: 2025
Volume: 51
Issue: 11
Print publication date: 01/11/2025
Online publication date: 03/09/2025
Acceptance date: 02/09/2025
ISSN (print): 0748-7983
ISSN (electronic): 1532-2157
Publisher: W.B. Saunders Ltd
URL: https://doi.org/10.1016/j.ejso.2025.110431
DOI: 10.1016/j.ejso.2025.110431
PubMed id: 40939444
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