An update of sentinel lymph node mapping in patients with ductal carcinoma in situ

Wilkie, Caren E.G.; White, Laura; Dupont, Elisabeth; Cantor, Alan; Cox, Charles E.

doi:10.1016/j.amjsurg.2005.06.011

Cited by 122 publications

(87 citation statements)

References 18 publications

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“…The rate of SLNB positivity has been found to range from 9.6% to 14% in patients with DCIS with microinvasion (DCISM) (Wilkie et al, 2005;Katz et al, 2006;Intra et al, 2008). Therefore, the use of SLNB is sufficiently more justified in patients with DCISM, as well as in patients with invasive breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Factors Predicting Microinvasion in Ductal Carcinoma in situ

Ozkan-Gurdal¹,

Cabıoğlu²,

Özçınar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Materials and Methods: 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). Results: 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95%CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS.

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Section: Introductionmentioning

confidence: 99%

Factors Predicting Microinvasion in Ductal Carcinoma in situ

Ozkan-Gurdal¹,

Cabıoğlu²,

Özçınar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…18 However, the presence of isolated tumor cells (ITCs) in the sentinel node was included in the definition of a positive sentinel lymph node biopsy in both prior publications. 5,18 According to the sixth edition of the American Joint Commission on Cancer (AJCC) breast cancer staging system, published in 2002, and the seventh edition, published in 2009, ITCs fail to represent a significant burden of nodal disease. Therefore, ITCs alone are not classified as nodal metastasis.…”

Section: Introductionmentioning

confidence: 99%

Role of Axillary Staging in Women Diagnosed With Ductal Carcinoma In Situ With Microinvasion

Pimiento

Lee

Esposito

et al. 2011

JOP

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“…Despite improvements in core biopsy sampling, with sophisticated imaging modalities and larger-gauge, vacuum-assisted needles, there is, nevertheless, a notinsignificant rate of upgrading from DCIS to invasive carcinoma from core biopsies to excisions reported in the literature. [18][19][20][21][22][23][24][25][26][27] Our study consisted of 2934 cases of DCIS diagnosed on core biopsies during 15 years and identified 229 cases in which the stage was upgraded to invasive carcinoma upon excision. That is an upgrade rate of 8%, which is within the range reported in the literature (0%-59%).…”

Section: Discussionmentioning

confidence: 99%

“…Underestimation of invasive carcinoma in patients with a core biopsy diagnosis of DCIS ranges from 0% to 59%. [18][19][20][21][22][23][24][25][26][27] This prompted us to examine the predictive value of a core biopsy diagnosis of DCIS, particularly the upgrade rate to invasive carcinoma, and to identify any associated factors that meet criteria for inclusion in surveillance clinical trials.…”

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confidence: 99%

Not All Ductal Carcinomas In Situ Are Created IDLE (Indolent Lesions of Epithelial Origin)

Alexander

Beyda

Nayak

et al. 2018

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Mammographic screening has increased the incidence of ductal carcinoma in situ (DCIS), but this has not been accompanied by a decline in the incidence of invasive carcinoma (IC). Consequently, the surgical treatment of DCIS has recently been questioned, with some advocating only surveillance (with or without neoadjuvant endocrine therapy) after a core biopsy diagnosis of DCIS.Objectives.-To examine the predictive value of a core biopsy diagnosis of DCIS, particularly the upgrade rate to IC, and to identify associated factors.Design.-Using the pathology database, we identified 2943 cases of DCIS diagnosed on core biopsy from 2000 to 2015, of which 229 cases (8%) later had the stage upgraded to IC.Results.-Ages ranged from 25 to 90 years (mean, 59 years). The DCIS presented with calcifications in 151 of 229 cases (65.9%), was widespread in 26 of 151 cases (17%), had a mass or density present in 70 of 229 cases (31%), with heterogeneous echogenic features in 44 of those 70 cases (63%), and an enhancement upon magnetic resonance imaging in 8 of 229 cases (3.5%). Of the 229 cases, the DCIS grades were as follows: low in 29 cases (13%), intermediate in 79 cases (36%), and high in 121 cases (53%). Of the 229 cases, necrosis was present in 152 (66.4%) and was comedo necrosis in 99 cases (43%). Of the 229 cases of IC, the tumor stage was as follows: microIC in 36 (16%), T1a in 119 (52%), T1b in 35 (15%), T1c in 28 (12%), T2 in 8 (3%), and T3 in 3 cases (1%). Axillary lymph nodes were staged in 167 patients as follows: N0, 141 cases (84%); N0(iþ), 14 cases (8%); and N1, 12 cases (7%). The 12 N1 cases were subclassified by T stage as follows: T1a, 1 case (8%); T1b, 4 cases (33%); T1c, 2 cases (17%); T2, 4 cases (33%); and T3, 1 case (8%). The IC cases of stage upgrading were predominantly smaller than 2 cm (218 of 229; 95%), and more than twothirds were smaller than 0.5 cm (155 of 229; 95%), most of which were accompanied by extensive DCIS.Conclusions.-Approximately one-half of the upgrades were associated with high-grade DCIS, especially with comedo necrosis; nevertheless, the other one-half of the upgrades were due to low-and intermediate-grade DCIS and should not be underestimated. There were few positive results from axillary lymph node biopsies, but they occurred in 3% (7 of 218) of the carcinomas smaller than 2 cm. Our findings indicate that caution is needed when DCIS cases diagnosed by core biopsy are treated nonsurgically with surveillance (with or without neoadjuvant endocrine therapy), given the number of cases (229 of 2943; 8%) that are upgraded to IC and those with axillary lymph node metastases (12 of 167; 7%).

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An update of sentinel lymph node mapping in patients with ductal carcinoma in situ

Cited by 122 publications

References 18 publications

Factors Predicting Microinvasion in Ductal Carcinoma in situ

Factors Predicting Microinvasion in Ductal Carcinoma in situ

Role of Axillary Staging in Women Diagnosed With Ductal Carcinoma In Situ With Microinvasion

Not All Ductal Carcinomas In Situ Are Created IDLE (Indolent Lesions of Epithelial Origin)

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