{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T10:09:33Z","timestamp":1759226973843},"reference-count":44,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T00:00:00Z","timestamp":1661904000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82073282"],"award-info":[{"award-number":["82073282"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100005047","name":"Natural Science Foundation of Liaoning Province","doi-asserted-by":"crossref","award":["2022-MS-221"],"award-info":[{"award-number":["2022-MS-221"]}],"id":[{"id":"10.13039\/501100005047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n               <jats:title>Background<\/jats:title>\n               <jats:p>Ductal carcinoma <jats:italic>in situ<\/jats:italic> (DCIS) has become a non-negligible part of breast cancers owing to the greatly increased incidence. While its natural history was not fully elucidated, which is the reason for current controversies in clinical treatment. Exploration of this issue from a clinical perspective is meaningful.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Methods<\/jats:title>\n               <jats:p>Medical records of 389 patients diagnosed with DCIS or DCIS with invasive ductal carcinoma (IDC) were reviewed. All of them received appropriate medical care in our center. All 324 patients in training cohort were divided into invasion and non-invasion groups based on pathology. Differences in DCIS immunohistochemical markers and hematological indicators between them were analyzed. In the invasion group, differences between DCIS and matched IDC were compared to explore changes in the tumor heterogeneity during invasion. Conclusions are validated in the validation cohort of 65 patients.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Results<\/jats:title>\n               <jats:p>Patients in invasion and non-invasion groups were balanced in baseline characteristics and no statistically significant differences were noticed for DCIS immunohistochemical markers. For hematological indicators, high expression of platelet &gt;291.50) (odds ratio, 2.46; CI [1.35\u20134.46]; <jats:italic>p<\/jats:italic> = 0.003) and SII (&gt;347.20) (odds ratio, 2.54; CI [1.56\u20134.12]; <jats:italic>p<\/jats:italic> &lt; 0.001) were established as independent predictors for invasion by logistic analysis and were validated in the validation cohort. Ki-67 of IDC was significantly higher than that of matched DCIS (<jats:italic>p<\/jats:italic> &lt; 0.001). HER2 expression and histological grade of DCIS were separately linearly related to those of IDC.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Conclusion<\/jats:title>\n               <jats:p>The change in hematological indicators is an independent predictor for invasion and can be incorporated into the treatment decision-making process for DCIS. Invasion tumor cells exhibit a stronger proliferative capacity compared with the <jats:italic>in-situ<\/jats:italic> ones. There are linear relationships in HER2 expression and histological grades between DCIS and matched IDC. DCIS subclones with different histological grades will develop into invasive carcinomas separately.<\/jats:p>\n            <\/jats:sec>","DOI":"10.7717\/peerj.13966","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T07:29:00Z","timestamp":1661930940000},"page":"e13966","source":"Crossref","is-referenced-by-count":1,"title":["An insight into the invasion of breast ductal carcinoma <i>in situ<\/i> based on clinical, pathological and hematological data"],"prefix":"10.7717","volume":"10","author":[{"given":"Yanbiao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zining","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinmiao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ang","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4443","published-online":{"date-parts":[[2022,8,31]]},"reference":[{"key":"10.7717\/peerj.13966\/ref-1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.4103\/1742-6413.92550","article-title":"Comparative evaluation of the modified Scarff-Bloom-Richardson grading system on breast carcinoma aspirates and histopathology","volume":"9","author":"Bansal","year":"2012","journal-title":"Cytojournal"},{"key":"10.7717\/peerj.13966\/ref-2","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1146\/annurev-med-050715-104920","article-title":"Controversies in the treatment of ductal carcinoma in situ","volume":"68","author":"Barrio","year":"2017","journal-title":"Annual Review of Medicine"},{"issue":"2","key":"10.7717\/peerj.13966\/ref-3","first-page":"134","article-title":"Distribution of estrogen receptor in ductal carcinoma in situ of the breast","volume":"113","author":"Chaudhuri","year":"1993","journal-title":"Surgery"},{"issue":"8","key":"10.7717\/peerj.13966\/ref-4","first-page":"634","article-title":"Research progress on the clinical value of Ki-67 in breast cancer and its cut-off definition","volume":"53","author":"Chen","year":"2015","journal-title":"Zhonghua Wai Ke Za Zhi"},{"issue":"21","key":"10.7717\/peerj.13966\/ref-5","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1200\/JCO.20.02824","article-title":"Comparison of radiation with or without concurrent trastuzumab for HER2-positive ductal carcinoma in situ resected by lumpectomy: a phase III clinical trial","volume":"39","author":"Cobleigh","year":"2021","journal-title":"Journal of Clinical Oncology"},{"issue":"9","key":"10.7717\/peerj.13966\/ref-6","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1002\/cncr.20979","article-title":"Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses\u2019 Health Study","volume":"103","author":"Collins","year":"2005","journal-title":"Cancer"},{"issue":"5","key":"10.7717\/peerj.13966\/ref-7","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1111\/j.1365-2559.1991.tb00229.x","article-title":"Pathological prognostic factors in breast cancer. 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