Axillary staging in ductal carcinoma in situ with microinvasion: A meta-analysis

Choi, Byung Ihn; Jegatheeswaran, Lavandan; Nakhoul, Maria; Haria, Payal; Srivastava, Reya; Karki, Smriti; Lupi, Micol; Patel, Vishal; Chakravorty, Arunmoy; Babu, E

doi:10.1016/j.suronc.2021.101557

Cited by 11 publications

(17 citation statements)

References 34 publications

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“…In this study, 19.5% of patients received ALND, 80.5% were non-ALND; the LNM rate was 6.4%, including 4.3% macrometastases and 2.1% N1mi. Of note, the LNM rate reduced to 1.3% macrometastases and 1.6% N1mi in the non-ALND subgroup, slightly lower than 2% and 3% in the latest meta-analysis by Choi [6]. With a median follow-up of 96 months, MBC showed an excellent survival with a 10-year BCSS of 96.3% in the total cohort.…”

Section: Discussionmentioning

confidence: 80%

“…As for varied LNM rates (1.5-20%) reported in the literature [6,8,[13][14][15][16], this may be partly attributable to different diagnostic criteria of MBC, inconsistent definitions of LNM, and varied SLN tracer and SLN evaluating methods. Firstly, though the concept "microinvasion" was proposed in 1982 [17], the definition of microinvasion was not internationally standardized until the 3rd edition of the WHO classification of tumors [18].…”

Section: Discussionmentioning

confidence: 99%

“…As for the axillary staging of MBC, some studies suggested that MBC had very similar survival rates to DCIS, and it should be treated and followed up as pure DCIS [2,13]. Others suggested that axillary staging may be an unnecessary intervention that does not change MBC management for the majority of MBC diagnosed postoperatively [6], and even routine SLNB is perhaps not useful for MBC [8]. However, 10-year BCSS declined from 97.0% in the N0 subgroup to 87.4% in the N+ subgroup in this study, which was in line with the results of three other research based on the SEER dataset [4,5,10].…”

Section: Discussionmentioning

confidence: 99%

“…The latest meta-analysis showed that MBC with the lymph node macrometastases rate of 2% had similar survival to DCIS and suggested that routine axillary staging may be an unnecessary intervention that does not change the management of MBC [6]. Sentinel lymph node biopsy (SLNB), a minimal invasion method that has comparable accuracy with axillary lymph node dissection (ALND), has become the mainstay in axillary staging for early breast cancer [7].…”

Section: Introductionmentioning

confidence: 99%

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Regional Lymph Node Metastasis and Axillary Surgery of Microinvasive Breast Cancer: A Population-Based Study

et al. 2022

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Microinvasive breast cancer (MBC for short) is a rare entity with the decision of axillary surgery under debate in clinical practice. We aimed to unravel the lymph node metastasis (LNM) rate, axillary surgery, and prognosis of MBC based on 11,692 patients derived from the Surveillance Epidemiology and End Results (SEER) database between 2003 and 2015. In this retrospective study, 19.5% (2276/11,692) of patients received axillary lymph node dissection (ALND), 80.5% (9416/11,692) received non-ALND. In the total cohort, 10-year breast cancer-specific survival (BCSS) was 96.3%, and the LNM rate was 6.4% (754/11,692). Multivariate analyses showed that LNM had the strongest predictive weight (N3, HR 14.200, 95% CI 7.933–25.417; N2, HR 12.945, 95% CI 7.725–21.694; N1, HR 3.05, 95% CI 2.246–4.140, all p < 0.001). Kaplan–Meier analyses showed that ALND did not confer a survival benefit on 10-year BCS in patients with N0 (94.7% vs. 97.1%, p < 0.001) and in patients with 1–2 positive nodes (92.1% vs. 89.5%, p = 0.355), respectively, when compared to non-ALND. Our study demonstrated that the vast majority of MBC have a low LNM rate and excellent prognosis; patients with LNM showed poor prognosis. Assessment of lymph node status is necessary, and non-ALND surgery is required and sufficient for MBC with 0–2 positive nodes.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Regional Lymph Node Metastasis and Axillary Surgery of Microinvasive Breast Cancer: A Population-Based Study

et al. 2022

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“…The rate associated with microinvasion was similar to that of small invasive carcinoma of up to 1 cm (6.8%) and lower than that for women with invasive carcinoma of 1.1–2.0 cm in size (12.1%). However, another, meta-analysis of axillary staging in patients with DCIS and microinvasion, that included 2959 patients from 23 studies, showed a survival rate of patients with microinvasion was overall very similar to those with pure DCIS [ 11 ]. In a smaller Chinese cohort, of 359 pure DCIS lesions and 80 DCIS with microinvasion and 31 months of follow-up, Fang et al reported that those with microinvasion had 3-year disease-free survival (DFS), similar to stage pT1a invasive carcinoma and poorer than pure DCIS but there was no significant difference in the overall survival between the three groups [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)—results from the UK Sloane Project

Shaaban

Hilton²,

Clements³

et al. 2022

Br J Cancer

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Background The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial. Methods We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project. Results Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0–25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005). Conclusions The higher breast cancer mortality with microinvasion indicates a more aggressive disease.

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Racial disparities in disease‐specific mortality and surgical management of patients with ductal carcinoma in situ with microinvasion

Chen,

Handley,

Elsaid

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesGiven persistent racial disparities in breast cancer outcomes, this study explores racial differences in disease‐specific mortality and surgical management among patients with microinvasive ductal carcinoma in situ (DCIS‐MI).MethodsThe Surveillance, Epidemiology, and End Results Program was queried for patients aged 18+ years with DCIS‐MI between January 1, 2010 and December 31, 2018. The study cohort was divided into non‐Hispanic Black (NHB) and non‐Hispanic White (NHW) patients. Disease‐specific mortality was evaluated using Cox proportional hazards models.ResultsA total of 3400 patients were identified, of which 569 (16.7%) were NHB and 2831 (83.3%) were NHW. Compared with NHW patients, NHB patients had more positive lymph nodes (7.6% vs. 3.9% p < 0.001). In addition, NHB women were more likely to undergo axillary lymph node dissection (6.0% vs. 3.8%, p = 0.044) and receive chemotherapy (11.8% vs. 7.2%, p < 0.001). There were no racial differences in breast surgery type (p = 0.168), reconstructive surgery (p = 0.362), or radiation therapy (p = 0.342). Overall, NHB patients had worse disease‐specific mortality (adjusted hazard ratio 2.13, 95% confidence interval [CI]: 1.10–4.14) with mortality risks diverging from NHW women after 3 years (6 years rate ratio [RR] 2.12, 95% CI: 1.13–4.34; 9 years RR 2.32, 95% CI: 1.24–4.35).ConclusionsNHB women with DCIS‐MI present with higher nodal disease burden and experience worse disease‐specific mortality than NHW women.

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Axillary staging in ductal carcinoma in situ with microinvasion: A meta-analysis

Cited by 11 publications

References 34 publications

Regional Lymph Node Metastasis and Axillary Surgery of Microinvasive Breast Cancer: A Population-Based Study

Regional Lymph Node Metastasis and Axillary Surgery of Microinvasive Breast Cancer: A Population-Based Study

The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)—results from the UK Sloane Project

Racial disparities in disease‐specific mortality and surgical management of patients with ductal carcinoma in situ with microinvasion

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