Overall, our study demonstrated that, for patients diagnosed with DCIS by CNB, larger tumor size on ultrasonography (>2 cm) and molecular subtype (ER+HER2+) were two independent predictors of upstaging, whereas larger tumor size on pathology (>2 cm) and multifocal lesions were the strongest risk factors of axillary metastasis. This evidence concerns the gene ESR1 and ductal breast carcinoma in situ.