Axillary Sentinel Lymph Node Biopsy in Patients With Pure Ductal Carcinoma In Situ of the Breast

Intra, Mattia; Veronesi, Paolo; Mazzarol, Giovanni; Galimberti, Viviana; Luini, Alberto; Sacchini, Virgilio; Trifirò, Giuseppe; Gentilini, Oreste; Pruneri, Giancarlo; Naninato, Paola; Torres, Fabio; Paganelli, Giovanni; Viale, Giuseppe; Veronesi, Umberto

doi:10.1001/archsurg.138.3.309

Cited by 145 publications

(75 citation statements)

References 16 publications

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“…They found that sentinel lymph nodes were positive for disease in 10% of patients with microinvasive DCIS (n ϭ 31) and in 12% of patients with palpable masses, masses evident on mammograms, or extensive high-grade lesions (n ϭ 76). In a European Institute of Oncology study of 223 unselected consecutive patients with pure DCIS, sentinel lymph node biopsy found nodal metastasis, mostly micrometastasis, in 3.1% of patients (n ϭ 7) [41]. More recently, Yen and colleagues evaluated 398 patients with an initial diagnosis of DCIS [42].…”

Section: Surgery For Dcismentioning

confidence: 99%

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

et al. 2007

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After completing this course, the reader will be able to:1. Discuss the role of radiation therapy in the adjuvant treatment of DCIS.2. Describe the impact of tamoxifen in the treatment of DCIS.3. Discuss evolving strategies in neoadjuvant treatment for DCIS.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTDuctal carcinoma in situ (DCIS) is the fastest growing subtype of breast cancer, mainly because of the aging of our populations and improvements in diagnostic mammography and core biopsy. DCIS represents a proliferation of malignant-appearing cells that have not invaded beyond the ductal basement membrane and is a precursor for the development of invasive breast cancer (IBC). Approximately 40% of patients with DCIS treated with biopsy alone, without complete excision or further therapy, develop IBC. Most DCIS itself is harmless if it is detected and excised before it can progress to IBC, and the current approach to DCIS treatment is aimed at just that goal. Typically, it consists of multimodal treatment including segmental mastectomy followed by radiation therapy to the whole breast and then hormonal therapy or total mastectomy followed by hormonal therapy.This review discusses the state-of-the-art in DCIS detection and treatment and highlights promising new strategies in the care of DCIS patients. The data regarding the effectiveness of breast-conserving surgery versus total mastectomy, the possible avoidance of radiation therapy in some subgroups of patients, and the role of hormonal agents are reviewed. Neoadjuvant therapy and the use of trastuzumab for DCIS are currently under investigation and may be future treatment options for DCIS. The Oncologist

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Section: Surgery For Dcismentioning

confidence: 99%

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

et al. 2007

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“…However, this is still controversial in DIN patients. In fact, for some authors SLNB should not, in general, be indicated [62]; for others, SLNB should always be carried out [63][64], and for others still, it should be performed only in certain specific and particular cases [65][66][67][68]. Major cancer centers agree that SLNB should be conducted a)…”

Section: Surgical Treatmentmentioning

confidence: 99%

The management of ductal intraepithelial neoplasia (DIN): open controversies and guidelines of the Istituto Europeo di Oncologia (IEO), Milan, Italy

Farante

Zurrida

Galimberti

et al. 2010

Breast Cancer Res Treat

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“…A study by Intra et al showed that examination of SLN by serial sectioning and IHC increases the detection rate of metastasis from, 9-33% in infiltrating carcinoma 27 .…”

Section: Sentinel Lymph Node Biopsy Techniquementioning

confidence: 99%

The Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer

Saha

Hossain

Saha

2015

J. Bangladesh Coll. Phys.

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The sentinel lymph node (SLN) is defined as the first node(s) receiving lymphatic drainage from a primary tumour. A promising alternative to axillary lymph node dissection (ALND) is sentinel lymph node biopsy. SLN biopsy has been introduced as a technique to identify axillary lymph node most likely to contain tumour cells metastasizing from a primary carcinoma of breast. Several methods of identifying the SLN exists, including the use of radioactive tracer, lymphazurin dye or combination of the two via intraparenchymal and/or intradermal, peritumoral or periaerolar injection sites. Intraoperative evaluation of SLNs are done by performing FS(Frozen Section) on all the lymph nodes after serially sectioning them at 3-4mm intervals; at least 2 levels are cut of all the sentinel lymph nodes. In addition, touch preparation cytology(TP) smear may also be made for evaluation. The limitations of SLNB is that a proportion of patients who have metastasis limited to the SLN can be predicted when there is a combination of tumour size <1.0cm, the absence of lymphovascular invasion and micrometastatic disease (<0.2cm) in SLN. However for patients with large breast cancer, the role of SLNB is controversial. Early studies of SLNB in large breast cancer patients demonstrated a high (8-18%) false negative rate, with the accuracy worsening with the increasing size. Excision of SLNs have an extremely low morbidity and a high degree of staging accuracy. A tumour-free SLN virtually excludes lymphatic involvement of the entire regional lymphatic basin. More than 50 observational studies of SLNB validated by a back up ALND demonstrate that SLNB is feasible, accurate and suitable for virtually all patients with operable clinically node negative disease. Sentinel lymph node biopsy not only provide prognostic information, but also aims to guide adjuvant therapy without the untoward side effects of complete axillary dissection.

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Axillary Sentinel Lymph Node Biopsy in Patients With Pure Ductal Carcinoma In Situ of the Breast

Abstract: Hypothesis: A sentinel lymph node (SLN) biopsy should not be considered a standard procedure in the treatment of all patients with ductal carcinoma in situ (DCIS) of the breast if the lesion is completely excised by radical surgery and there are free margins of resection.

Cited by 145 publications

References 16 publications

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

The management of ductal intraepithelial neoplasia (DIN): open controversies and guidelines of the Istituto Europeo di Oncologia (IEO), Milan, Italy

The Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer

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