{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:59:59Z","timestamp":1790380799033,"version":"4.1.0"},"reference-count":42,"publisher":"Elsevier BV","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005026","name":"Foundation Against Cancer","doi-asserted-by":"publisher","award":["2025-048"],"award-info":[{"award-number":["2025-048"]}],"id":[{"id":"10.13039\/501100005026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002661","name":"Fund for Scientific Research","doi-asserted-by":"publisher","award":["40033175"],"award-info":[{"award-number":["40033175"]}],"id":[{"id":"10.13039\/501100002661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013845","name":"Fondation contre le Cancer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013845","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011068","name":"Fondation Saint-Luc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["mp.uscap.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Modern Pathology"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.modpat.2026.101040","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T15:23:54Z","timestamp":1784388234000},"page":"101040","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Immunohistochemistry-based Decision Flowchart to De-escalate Axillary Surgery for Biopsy-Diagnosed Pure Ductal Carcinoma In Situ (DCIS) of the Breast"],"prefix":"10.1016","volume":"39","author":[{"given":"Julia A.M.","family":"Riggi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Galant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Bouzin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Daumerie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na\u00efma","family":"Benhaddi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"Vernaeve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanael","family":"Dubois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maud","family":"Vassilieff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"Roman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Latifa","family":"Fellah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandine","family":"Gerday","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolien H.M.","family":"van Deurzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Berli\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mieke R.","family":"Van Bockstal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"4","key":"10.1016\/j.modpat.2026.101040_bib1","doi-asserted-by":"crossref","first-page":"462","DOI":"10.5858\/arpa.2012-0078-RA","article-title":"Ductal carcinoma in situ of the breast: current concepts and future directions","volume":"137","author":"Siziopikou","year":"2013","journal-title":"Arch Pathol Lab Med"},{"issue":"4","key":"10.1016\/j.modpat.2026.101040_bib2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1038\/s41416-019-0478-6","article-title":"Ductal carcinoma in situ: to treat or not to treat, that is the question","volume":"121","author":"van Seijen","year":"2019","journal-title":"Br J Cancer"},{"key":"10.1016\/j.modpat.2026.101040_bib3","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.clinimag.2020.11.050","article-title":"Symptomatic ductal carcinoma in situ (DCIS): upstaging risk and predictors","volume":"73","author":"Venkatesh","year":"2021","journal-title":"Clin Imaging"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib4","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1002\/ijc.32362","article-title":"A retrospective alternative for active surveillance trials for ductal carcinoma in situ of the breast","volume":"146","author":"Van Bockstal","year":"2020","journal-title":"Int J Cancer"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib5","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 situ of the breast: a hypothesis-generating systematic review","volume":"93","author":"Riggi","year":"2026","journal-title":"Pathobiology"},{"issue":"3","key":"10.1016\/j.modpat.2026.101040_bib6","doi-asserted-by":"crossref","DOI":"10.1093\/radadv\/umaf007","article-title":"Mitigating overtreatment of ductal carcinoma in situ","volume":"2","author":"Chung","year":"2025","journal-title":"Radiol Adv"},{"issue":"6","key":"10.1016\/j.modpat.2026.101040_bib7","doi-asserted-by":"crossref","first-page":"691","DOI":"10.6004\/jnccn.2022.0030","article-title":"Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology","volume":"20","author":"Gradishar","year":"2022","journal-title":"J Natl Compr Canc Netw"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib8","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1200\/JCO.2016.71.0947","article-title":"Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update","volume":"35","author":"Lyman","year":"2017","journal-title":"J Clin Oncol"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib9","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s12957-025-03926-8","article-title":"Is axillary surgery still justified in DCIS diagnosed via vacuum-assisted biopsy?","volume":"23","author":"Ramos","year":"2025","journal-title":"World J Surg Oncol"},{"issue":"6","key":"10.1016\/j.modpat.2026.101040_bib10","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1245\/s10434-018-6410-0","article-title":"Associations between sentinel lymph node biopsy and complications for patients with ductal carcinoma in situ","volume":"25","author":"Killelea","year":"2018","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"10.1016\/j.modpat.2026.101040_bib11","doi-asserted-by":"crossref","DOI":"10.1200\/EDBK_438776","article-title":"Personalizing locoregional therapy in patients with breast cancer in 2024: tailoring axillary surgery, escalating lymphatic surgery, and implementing evidence-based hypofractionated radiotherapy","volume":"44","author":"Weber","year":"2024","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"11","key":"10.1016\/j.modpat.2026.101040_bib12","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1056\/NEJMoa2412063","article-title":"Axillary surgery in breast cancer \u2014 primary results of the INSEMA Trial","volume":"392","author":"Reimer","year":"2025","journal-title":"N Engl J Med"},{"issue":"11","key":"10.1016\/j.modpat.2026.101040_bib13","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1001\/jamaoncol.2023.3759","article-title":"Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial","volume":"9","author":"Gentilini","year":"2023","journal-title":"JAMA Oncol"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib14","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s12885-022-09273-1","article-title":"No axillary surgical treatment for lymph node-negative patients after ultra-sonography [NAUTILUS]: protocol of a prospective randomized clinical trial","volume":"22","author":"Jung","year":"2022","journal-title":"BMC Cancer"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib15","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1186\/s12885-017-3443-x","article-title":"Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013-08)","volume":"17","author":"van Roozendaal","year":"2017","journal-title":"BMC Cancer"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5858\/133.1.15","article-title":"Protocol for the examination of specimens from patients with ductal carcinoma in situ of the breast","volume":"133","author":"Lester","year":"2009","journal-title":"Arch Pathol Lab Med"},{"issue":"3","key":"10.1016\/j.modpat.2026.101040_bib17","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1038\/s41379-019-0367-9","article-title":"Interobserver variability in upfront dichotomous histopathological assessment of ductal carcinoma in situ of the breast: the DCISion study","volume":"33","author":"Dano","year":"2020","journal-title":"Mod Pathol"},{"issue":"4","key":"10.1016\/j.modpat.2026.101040_bib18","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.ejso.2018.11.005","article-title":"Stromal characteristics are adequate prognosticators for recurrence risk in ductal carcinoma in situ of the breast","volume":"45","author":"Van Bockstal","year":"2019","journal-title":"Eur J Surg Oncol"},{"issue":"2","key":"10.1016\/j.modpat.2026.101040_bib19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/annonc\/mdu450","article-title":"The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014","volume":"26","author":"Salgado","year":"2015","journal-title":"Ann Oncol"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib20","doi-asserted-by":"crossref","first-page":"545","DOI":"10.5858\/arpa.2019-0904-SA","article-title":"Estrogen and progesterone receptor testing in breast cancer: American Society of Clinical Oncology\/College of American Pathologists guideline update","volume":"144","author":"Allison","year":"2020","journal-title":"Arch Pathol Lab Med"},{"issue":"11","key":"10.1016\/j.modpat.2026.101040_bib21","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.5858\/arpa.2018-0902-SA","article-title":"Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology\/College of American Pathologists clinical practice guideline focused update","volume":"142","author":"Wolff","year":"2018","journal-title":"Arch Pathol Lab Med"},{"issue":"19","key":"10.1016\/j.modpat.2026.101040_bib22","doi-asserted-by":"crossref","first-page":"5317","DOI":"10.1158\/1078-0432.CCR-21-1239","article-title":"Prognostic and predictive value of HER2 expression in ductal carcinoma in situ: results from the UK\/ANZ DCIS randomized trial","volume":"27","author":"Thorat","year":"2021","journal-title":"Clin Cancer Res"},{"issue":"2","key":"10.1016\/j.modpat.2026.101040_bib23","first-page":"153","article-title":"Predictive markers for pathological complete response (pCR) after neo-adjuvant chemotherapy in HER2-positive breast carcinoma","volume":"39","author":"Van Bockstal","year":"2024","journal-title":"Histol Histopathol"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib24","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-017-17204-5","article-title":"QuPath: open source software for digital pathology image analysis","volume":"7","author":"Bankhead","year":"2017","journal-title":"Sci Rep"},{"issue":"12","key":"10.1016\/j.modpat.2026.101040_bib25","doi-asserted-by":"crossref","first-page":"7069","DOI":"10.1245\/s10434-023-13929-y","article-title":"Validation and clinical utility of a prediction model for the risk of upstaging to invasive breast cancer after a biopsy diagnosis ductal carcinoma in situ","volume":"30","author":"Meurs","year":"2023","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib26","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12893-017-0210-5","article-title":"DCIS and axillary nodal evaluation: compliance with national guidelines","volume":"17","author":"Mitchell","year":"2017","journal-title":"BMC Surg"},{"issue":"4","key":"10.1016\/j.modpat.2026.101040_bib27","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1002\/jso.23273","article-title":"Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy","volume":"107","author":"Park","year":"2013","journal-title":"J Surg Oncol"},{"issue":"4","key":"10.1016\/j.modpat.2026.101040_bib28","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1007\/s12282-021-01225-0","article-title":"Clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with ductal carcinoma in situ (DCIS): a multi-institutional retrospective cohort study","volume":"28","author":"Tanaka","year":"2021","journal-title":"Breast Cancer"},{"issue":"2","key":"10.1016\/j.modpat.2026.101040_bib29","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s10549-019-05362-1","article-title":"Reliability of preoperative breast biopsies showing ductal carcinoma in situ and implications for non-operative treatment: a cohort study","volume":"178","author":"Mannu","year":"2019","journal-title":"Breast Cancer Res Treat"},{"key":"10.1016\/j.modpat.2026.101040_bib30","doi-asserted-by":"crossref","DOI":"10.1016\/j.suronc.2024.102128","article-title":"Radiological and pathological predictors of post-operative upstaging of breast ductal carcinoma in situ (DCIS) to invasive ductal carcinoma and lymph-nodes metastasis; a potential algorithm for node surgical de-escalation","volume":"56","author":"Vanni","year":"2024","journal-title":"Surg Oncol"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib31","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41523-021-00364-z","article-title":"Ductal carcinoma in situ: a risk prediction model for the underestimation of invasive breast cancer","volume":"8","author":"Park","year":"2022","journal-title":"NPJ Breast Cancer"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib32","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1309\/HCF035N9WK40ETJ0","article-title":"Bimodal frequency distribution of estrogen receptor immunohistochemical staining results in breast cancer: an analysis of 825 Cases","volume":"123","author":"Collins","year":"2005","journal-title":"Am J Clin Pathol"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib33","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s13058-024-01875-w","article-title":"Systematic assessment of HER2 status in ductal carcinoma in situ of the breast: a perspective on the potential clinical relevance","volume":"26","author":"Van Bockstal","year":"2024","journal-title":"Breast Cancer Res"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib34","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s00428-017-2161-8","article-title":"Comparison of HER2 amplification status among breast cancer subgroups offers new insights in pathways of breast cancer progression","volume":"471","author":"Lambein","year":"2017","journal-title":"Virchows Arch"},{"issue":"1","key":"10.1016\/j.modpat.2026.101040_bib35","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/path.3990","article-title":"Genomic and mutational profiling of ductal carcinomas in situ and matched adjacent invasive breast cancers reveals intra-tumour genetic heterogeneity and clonal selection","volume":"227","author":"Hernandez","year":"2012","journal-title":"J Pathol"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib36","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s13402-011-0043-7","article-title":"Molecular differences between ductal carcinoma in situ and adjacent invasive breast carcinoma: a multiplex ligation-dependent probe amplification study","volume":"34","author":"Moelans","year":"2011","journal-title":"Cell Oncol (Dordr)"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib37","doi-asserted-by":"crossref","first-page":"674","DOI":"10.6061\/clinics\/2013(05)15","article-title":"Immunohistochemical profile of high-grade ductal carcinoma in situ of the breast","volume":"68","author":"Perez","year":"2013","journal-title":"Clinics (Sao Paulo)"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib38","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/j.1365-2559.1991.tb00229.x","article-title":"Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up","volume":"19","author":"Elston","year":"1991","journal-title":"Histopathology"},{"issue":"5","key":"10.1016\/j.modpat.2026.101040_bib39","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1093\/ajcp\/aqaa077","article-title":"Interobserver variability in ductal carcinoma in situ of the breast","volume":"154","author":"Van Bockstal","year":"2020","journal-title":"Am J Clini Pathol"},{"key":"10.1016\/j.modpat.2026.101040_bib40","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.breast.2016.02.014","article-title":"Ductal carcinoma in situ diagnosed by breast needle biopsy: predictors of invasion in the excision specimen","volume":"27","author":"Doebar","year":"2016","journal-title":"Breast"},{"issue":"10","key":"10.1016\/j.modpat.2026.101040_bib41","doi-asserted-by":"crossref","first-page":"2861","DOI":"10.1158\/1078-0432.CCR-20-4635","article-title":"Prognostic value of ER and PgR expression and the impact of multi-clonal expression for recurrence in ductal carcinoma in situ: results from the UK\/ANZ DCIS trial","volume":"27","author":"Thorat","year":"2021","journal-title":"Clin Cancer Res"},{"issue":"2","key":"10.1016\/j.modpat.2026.101040_bib42","doi-asserted-by":"crossref","DOI":"10.1016\/j.jogoh.2020.101928","article-title":"Negative estrogen receptors and positive progesterone receptors breast cancers","volume":"50","author":"Delvall\u00e9e","year":"2021","journal-title":"J Gynecol Obstet Hum Reprod"}],"container-title":["Modern Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0893395226000839?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0893395226000839?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:13:48Z","timestamp":1790378028000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0893395226000839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":42,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["S0893395226000839"],"URL":"https:\/\/doi.org\/10.1016\/j.modpat.2026.101040","relation":{},"ISSN":["0893-3952"],"issn-type":[{"value":"0893-3952","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"An Immunohistochemistry-based Decision Flowchart to De-escalate Axillary Surgery for Biopsy-Diagnosed Pure Ductal Carcinoma In Situ (DCIS) of the Breast","name":"articletitle","label":"Article Title"},{"value":"Modern Pathology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.modpat.2026.101040","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 THE AUTHORS. Published by Elsevier Inc. on behalf of the United States & Canadian Academy of Pathology.","name":"copyright","label":"Copyright"}],"article-number":"101040"}}