In patients without radiologically axillary lymph node metastasis, symptoms with a palpable mass or bloody nipple discharge (adjusted OR, 2.52, 95% CI, 1.40–4.54; p = 0.002), and high Ki-67 (adjusted OR, 2.14, 95% CI, 1.04–4.41; p = 0.040) were independent factors predictive of DCIS upgrade to invasive cancer (Supplementary Table 3). This evidence concerns the gene MKI67 and ductal breast carcinoma in situ.