{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:20:17Z","timestamp":1788445217757,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","award":["KMU\u2010DK(B)115004\u20101"],"award-info":[{"award-number":["KMU\u2010DK(B)115004\u20101"]}],"id":[{"id":"10.13039\/501100004694","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC115\u20102221\u2010E\u2010037\u2010006"],"award-info":[{"award-number":["NSTC115\u20102221\u2010E\u2010037\u2010006"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC113\u20102221\u2010E\u2010037\u2010007\u2010MY2"],"award-info":[{"award-number":["NSTC113\u20102221\u2010E\u2010037\u2010007\u2010MY2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Preoperative diagnosis of ductal carcinoma in\u00a0situ (DCIS) may be followed by pathological upstaging to invasive ductal carcinoma (IDC) upon surgical excision, a discrepancy that significantly impacts surgical planning and decisions regarding sentinel lymph node biopsy (SLNB). This retrospective study aimed to evaluate clinical indicators associated with such upstaging and develop a nomogram\u2010based clinical estimation model for risk stratification. We reviewed medical records of all consecutively diagnosed patients (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009445) initially diagnosed with DCIS via core needle biopsy (CNB) or vacuum\u2010assisted biopsy (VAB) between 2013 and 2022 at a single institution. Demographic, imaging, clinicopathological, immunohistochemical, and blood\u2010based biomarkers were categorized and analyzed. Logistic regression analysis was employed to identify independent predictors, from which a visual risk estimation tool was constructed. Among the 445 patients, 137 (30.8%) were upstaged to IDC. In the multivariable analysis, clinical tumor size\u2009&gt;\u20091.5\u2009cm, biopsy modality, and high histologic grade at biopsy emerged as independent predictors of pathological upstaging. Notably, VAB was associated with a lower rate of underestimation than CNB. Subgroup analyses revealed that age\u2009&gt;\u200950\u2009years, larger lesion size, and high grade were associated with upstaging in the CNB group, whereas histologic grade was the primary predictor in the VAB group. The nomogram demonstrated modest discriminative performance (AUC\u2009=\u20090.690) for individualized preoperative assessment. In conclusion, clinical tumor size, biopsy method, and histologic grade provide valuable information for estimating the likelihood of occult invasive disease in patients with preoperative DCIS.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70282","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:05:26Z","timestamp":1788444326000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Nomogram\u2010Based Clinical Estimation Model for Pathological Upstaging in Patients With Preoperative Ductal Carcinoma In\u00a0Situ"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1235-3451","authenticated-orcid":false,"given":"Yu\u2010Hua","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cancer Center Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung\u2010Liang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping\u2010Fu","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Breast Oncology and Surgery Kaohsiung Medical University Gangshan Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7381-1045","authenticated-orcid":false,"given":"Hui\u2010Hua","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Cancer Center Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Hematology and Oncology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5192-2748","authenticated-orcid":false,"given":"Fang\u2010Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sin\u2010Hua","family":"Moi","sequence":"additional","affiliation":[{"name":"College of Medicine, Graduate Institute of Clinical Medicine Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Faculty of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Medical Research Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Center for Disease Multi\u2010Omics Research Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Precision Sports Medicine and Health Promotion Center Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"15","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"2568","DOI":"10.1002\/cncr.35444","article-title":"Global Cancer Statistics 2022: The Report Offers a View on Disparities in the Incidence and Mortality of Cancer by Sex and Region Worldwide and on the Areas Needing Attention","volume":"130","author":"Nierengarten M. B.","year":"2024","journal-title":"Cancer"},{"issue":"3","key":"e_1_2_8_3_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung H.","year":"2021","journal-title":"CA: A Cancer Journal for Clinicians"},{"issue":"9805","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1016\/S0140-6736(11)61350-0","article-title":"MRI for Breast Cancer Screening, Diagnosis, and Treatment","volume":"378","author":"Morrow M.","year":"2011","journal-title":"Lancet"},{"issue":"4","key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.cpet.2023.04.003","article-title":"Breast Cancer Screening and Diagnosis: Recent Advances in Imaging and Current Limitations","volume":"18","author":"Gegios A. R.","year":"2023","journal-title":"PET Clinics"},{"issue":"1","key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1148\/radiol.11102368","article-title":"Ductal Carcinoma In\u00a0Situ at Core\u2010Needle Biopsy: Meta\u2010Analysis of Underestimation and Predictors of Invasive Breast Cancer","volume":"260","author":"Brennan M. E.","year":"2011","journal-title":"Radiology"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"4449","DOI":"10.1007\/s00330-025-12299-1","article-title":"Vacuum\u2010Assisted Breast Biopsy vs Core Needle Biopsy: A Systematic Review and Meta\u2010Analysis","volume":"36","author":"Sharma N.","year":"2026","journal-title":"European Radiology"},{"issue":"4","key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"e273","DOI":"10.1016\/j.clbc.2023.03.006","article-title":"The Upgrade Risk of B3 Lesions to (Pre) Invasive Breast Cancer After Diagnosis on Core Needle or Vacuum Assisted Biopsy. A Belgian National Cohort Study","volume":"23","author":"Willers N.","year":"2023","journal-title":"Clinical Breast Cancer"},{"issue":"1","key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41523-021-00364-z","article-title":"Ductal Carcinoma In\u00a0Situ: A Risk Estimation Model for the Underestimation of Invasive Breast Cancer","volume":"8","author":"Park K. W.","year":"2022","journal-title":"NPJ Breast Cancer"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.suronc.2022.101880","article-title":"Precise Application of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma In\u00a0Situ: A Systematic Review and Meta\u2010Analysis of Real\u2010World Data","volume":"45","author":"Chiu C. W.","year":"2022","journal-title":"Surgical Oncology"},{"issue":"2","key":"e_1_2_8_11_1","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrac022","article-title":"Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma In\u00a0Situ: Systematic Review and Meta\u2010Analysis","volume":"6","author":"Davey M. G.","year":"2022","journal-title":"BJS Open"},{"issue":"1","key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.amjsurg.2016.04.019","article-title":"Is Sentinel Lymph Node Biopsy Indicated in Patients With a Diagnosis of Ductal Carcinoma In\u00a0Situ? A Systematic Literature Review and Meta\u2010Analysis","volume":"213","author":"El Hage Chehade H.","year":"2017","journal-title":"American Journal of Surgery"},{"issue":"11","key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1001\/jama.2024.26698","article-title":"Active Monitoring With or Without Endocrine Therapy for Low\u2010Risk Ductal Carcinoma In\u00a0Situ: The COMET Randomized Clinical Trial","volume":"333","author":"Hwang E. S.","year":"2025","journal-title":"JAMA"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejca.2023.113276","article-title":"Active Surveillance Versus Treatment in Low\u2010Risk DCIS: Women's Preferences in the LORD\u2010Trial","volume":"192","author":"Schmitz R. S.","year":"2023","journal-title":"European Journal of Cancer"},{"issue":"7","key":"e_1_2_8_15_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejso.2025.109716","article-title":"A Retrospective Study Evaluating Surgical Upstaging Rates in Low\u2010Risk DCIS Patients Meeting the Eligibility Criteria for Active Surveillance Trials","volume":"51","author":"Vila J.","year":"2025","journal-title":"European Journal of Surgical Oncology"},{"issue":"5","key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"3234","DOI":"10.1245\/s10434-024-16837-x","article-title":"Preoperative MRI to Predict Upstaging of DCIS to Invasive Cancer at Surgery","volume":"32","author":"Javid S. 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L.","year":"2025","journal-title":"Breast Cancer Research and Treatment"},{"issue":"5","key":"e_1_2_8_19_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.esmoop.2024.102974","article-title":"Pan\u2010Asian Adapted ESMO Clinical Practice Guidelines for the Diagnosis, Treatment and Follow\u2010Up of Patients With Early Breast Cancer","volume":"9","author":"Park K. H.","year":"2024","journal-title":"ESMO Open"},{"issue":"5","key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1097\/JS9.0000000000000257","article-title":"The Comparison of Efficacy and Safety Evaluation of Vacuum\u2010Assisted Elite 10\u2010G System and the Traditional BARD 14\u2010G Core Needle in Breast Diagnosis: An Open\u2010Label, Parallel, Randomized Controlled Trial","volume":"109","author":"Zhang Y.","year":"2023","journal-title":"International Journal of Surgery"},{"issue":"3","key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1007\/s00432-020-03481-7","article-title":"Discrepancies Between Radiological and Histological Findings in Preoperative Core Needle (CNB) and Vacuum\u2010Assisted (VAB) Breast Biopsies","volume":"147","author":"Jorg I.","year":"2021","journal-title":"Journal of Cancer Research and Clinical Oncology"},{"issue":"10","key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.21037\/gs-2025-169","article-title":"Predictors and Nomogram for Upstaging to Invasive Breast Carcinoma in Ductal Carcinoma In\u00a0Situ Diagnosed by Ultrasound\u2010Guided Core Needle Biopsy","volume":"14","author":"Zhang X.","year":"2025","journal-title":"Gland Surgery"},{"issue":"1","key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1159\/000547335","article-title":"Predictive Histopathological Markers for Upstaging to Invasive Carcinoma After a Biopsy Diagnosis of Ductal Carcinoma In\u00a0Situ of the Breast: A Hypothesis\u2010Generating Systematic Review","volume":"93","author":"Riggi J. A. M.","year":"2026","journal-title":"Pathobiology"},{"issue":"5","key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1158\/1055-9965.EPI-18-0976","article-title":"Predictors of an Invasive Breast Cancer Recurrence After DCIS: A Systematic Review and Meta\u2010Analyses","volume":"28","author":"Visser L. L.","year":"2019","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"}],"container-title":["The Kaohsiung Journal of Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70282","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/kjm2.70282","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70282","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:05:29Z","timestamp":1788444329000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/kjm2.70282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":23,"alternative-id":["10.1002\/kjm2.70282"],"URL":"https:\/\/doi.org\/10.1002\/kjm2.70282","archive":["Portico"],"relation":{},"ISSN":["1607-551X","2410-8650"],"issn-type":[{"value":"1607-551X","type":"print"},{"value":"2410-8650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"assertion":[{"value":"2026-03-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70282"}}