Sheaffer WW, et al. - Given a wide variation in the upstaging from DCIS to invasive ductal carcinoma, researchers sought risk factors correlated with upstaging in all DCIS patients and based on specific surgical intervention. they reviewed 623 patients with a pre-operative diagnosis of DCIS undergoing BCT or mastectomy and identified upstaging in 74 patients (12%) overall. Suspicion of microinvasion, surgeon suspicion of invasive disease, and larger size/multicentric/extensive tumor were identified as factors that could increase the risk of upstaging. Upstaging rates were not significantly different between mastectomy and BCT. Sentinel lymph node biopsy in BCT patients without these high-risk features is hardly supported.