Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ

Kelly, Tricia; Kim, Julian A.; Patrick, Rebecca J.; Grundfest, Sharon; Crowe, Joseph P.

doi:10.1016/s0002-9610(03)00276-9

Cited by 70 publications

(39 citation statements)

References 7 publications

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“…Advocates of SLN biopsy in DCIS at the time of excision suggest that SLN biopsy may not be reliable after tumour excision and that patients should undergo an axillary lymph node dissection if a SLN biopsy was not performed at the time of the first operation 52 . However, others argue that SLN biopsy can be performed Reference Cserni 39 Kelly et al 20 Intra et al 21 Farkas et al 22 Veronesi et al 40 Zavagno et al 23 Katz et al 30 Mabry et al 15 Leidenius et al 41 Sakr et al 42 Di Saverio et al 43 Overall 0·100 0·023 0·031 0·011 0·018 0·020 0·073 0·059 0·068 0·103 0·125 0·037 0·005 0·050 0·500…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Ansari

Ogston

Purdie

et al. 2008

British Journal of Surgery

104

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Ansari

Ogston

Purdie

et al. 2008

British Journal of Surgery

104

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“…Therefore, ''patients with DCIS will be better served by more thorough pathologic evaluation and more careful surgical attention to margins than by a questionable value of a sentinel lymph node procedure, particularly one that employs Immuno-Histo-Chemistry'' [56]. Usually the low rate (0.8-2%) of axillary lymph node involvement reported in literature [57][58][59][60][61] for DCIS lesions is attributed to undetected invasive or microinvasive foci or to the histologically subtle loss of a restricting basement membrane, often associated with high grade intraductal lesions [62]. In our policy we usually consider SLNB for those patients with ''high risk'' DCIS lesions to be candidates for mastectomy.…”

Section: Discussionmentioning

confidence: 99%

259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up

Saverio

Catena

Santini

et al. 2007

Breast Cancer Res Treat

117

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Although in our series there is not a significant difference in LR rates by the parameter of age, the new USC/VNPI is still a simple and reliable scoring system for therapeutic management of DCIS. We did not find any statistically significant advantage in groups treated with the addition of RT. Obtaining wide surgical margins appears to be the strongest prognostic factor for local recurrence, regardless of other pathological factors or the addition of adjuvant radiation therapy. However, only prospective randomized studies can precisely predict the risk of LR of conservatively treated DCIS. The clinical significance of Sentinel Lymph Nodes micrometastases Immuno-Histo-Chemistry-detected found in DCIS patients remains uncertain. However, we hypothesize that the anatomical disruption after preoperative biopsy procedures increases the likelihood of epithelial cell displacement and the frequency of IHC-positive Sentinel Lymph Nodes, both of which are directly proportional to the degree of manipulation.

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“…1-2% despite surgical in sano removal of the tumor [4]. This might be due to the axillary micrometastasis observed in up to 3% DCIS patients and/or the presence of occult (micro-)metastases at the time of surgery, implying occult microinvasion or an invasive lesion that was not detected by standard pathological workup of the specimen [5,6].…”

Section: Introductionmentioning

confidence: 99%

Hematogenous and lymphatic tumor cell dissemination may be detected in patients diagnosed with ductal carcinoma in situ of the breast

Banys

Gruber

Krawczyk

et al. 2011

Breast Cancer Res Treat

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Tumor cell dissemination in bone marrow (BM) and lymph nodes is considered an important step in systemic disease progression and is associated with poor prognosis. Only invasive cancers are assumed to shed isolated tumor cells (ITC) into the bloodstream and infiltrate lymph nodes. However, latest studies indicate that tumor cell dissemination may occur before stroma invasion, i.e., in ductal carcinoma in situ (DCIS). Therefore, the purpose of this study was to examine the incidence of ITC in bone marrow and sentinel lymph nodes (SN) in patients diagnosed with DCIS and its correlation with clinicopathological factors. 266 patients who were treated at the Department of Gynecology and Obstetrics (University Hospital Tuebingen, Germany) between 2003 and 2009 with DCIS were included into this study. BM aspirates were analyzed by immunocytochemistry (pancytokeratin antibody A45-B/B3) using ACIS system (Chromavision) according to the ISHAGE evaluation criteria. SN were analyzed in 221 of these patients by extensive step sectioning and hematoxylin-eosin staining. In 34 of 266 patients (13%), ITC in BM could be detected. There was no correlation found between tumor size, grading, histology, or Van Nuys Prognostic Index and tumor cell dissemination. In two cases, metastatic spread into lymph nodes was observed (pN1mi), whereas in one case, ITC in lymph nodes were detected; however, additional sectioning and immunohistochemical staining of the primary lesion in the cases with positive SN did not reveal invasive cancer. Interestingly, all the three patients were BM negative. Tumor cell dissemination may be detected in patients diagnosed with DCIS. Either these cells have started already to disseminate from preinvasive mammary lesions or from occult invasive tumors or represent the earliest step of microinvasion in a preinvasive lesion. The clinical relevance of these cells has to be further evaluated.

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Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ

Cited by 70 publications

References 7 publications

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up

Hematogenous and lymphatic tumor cell dissemination may be detected in patients diagnosed with ductal carcinoma in situ of the breast

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