A prediction model for underestimation of invasive breast cancer for patients with a biopsy diagnosis of Ductal Carcinoma In Situ (DCIS)
This model calculates the predicted risk for underestimation of invasive breast cancer after a DCIS diagnosis by biopsy. The model uses pre-operatively known risk factors: the detection mode, the biopsy DCIS grade, palpability of the tumour, the BI-RADS score and the presence of a histologic suspected invasive component.
Research authors: Claudia J.C. Meurs, Joost van Rosmalen, Marian B.E. Menke-Pluijmers, Bert P.M. ter Braak, Linda de Munck, Sabine Siesling, Pieter J. Westenend
Details Formula Study characteristics Files & References
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MeSH terms
  • DCIS
  • Breast Cancer
  • Sentinel Node
  • Breast
  • Model type
    Logistic regression (Calculation)
    No Formula defined yet
    Condition Formula

    Additional information

    The data are population based data from the Netherlands, incidence in 2011 or 2012.

    Of the 2,892 DCIS diagnosis at biopsy, 596 (20.6%) were underestimated as the diagnosis was invasive breast cancer at excision.

    Characteristics of the study population: mean age 58.7 years, 66% was screen-detected, 22% was palpable, 75% had BI-RADS score 4 and 12% had BI-RADS score 5, 5% had a suspected invasive component at biopsy and the DCIS grade distribution was 15% low, 39% intermediate and 46% high.

    In total, 379 (13%) had missing data for one or more risk factor: 148 for palpability, 223 for BI-RADS score, 84 for DCIS grade and 81 for detection mode. To account for missing data, multiple imputation with fully conditional specification was used in the multivariable logistic analysis. 20 imputed data sets were generated, and the results were pooled according to Rubin’s rules.

    Study Population

    Total population size: 2892

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Detection mode Screening 1850
    Otherwise 961
    DCIS histological grade at biopsy Low 422
    Intermediate 1083
    High 1303
    Palpable No 2147
    Yes 597
    BI-RADS score 3 365
    4 1996
    5 308
    Suspect invasive component at biopsy No 2743
    Yes 149
    A prediction model for underestimation of invasive breast cancer for patients with a biopsy diagnosis of Ductal Carcinoma In Situ (DCIS)
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

    Related files

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    Predicted risk:

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    Outcome stratification

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    Conditional information

    Result interpretation

    Overall information regarding the model:
    The model was based on 2,892 cases of DCIS and 589 events of underestimated invasive breast cancer. The predicted risks in our study ranged from 9.5% to 80.2%, the mean was 20.6% and the median was 14.7%. The c-index was 0.668 and it was 0.661 after correction for optimism by bootstrapping. In this study the sensitivity was the rate of underestimates that was correctly predicted as high-risk and 1-specificity was the rate of DCIS at excision that was falsely predicted as high-risk. The model has not been validated externally.

    How to use the model:
    The model can be used to calculate the individual risk of underestimation based on routinely available pre-operatively known risk factors

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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