Does sentinel lymph node biopsy for screening high-grade ductal carcinoma in situ of the breast cause more harm than good?

Ramzi, Saed; Najeeb, Erum; Coulthard, James; Jenkins, Stephanie

doi:10.1007/s10549-020-05690-7

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…Ductal carcinoma in situ (DCIS) of the breast accounts for 10–20% of all newly detected breast cancer cases, which is a non-obligate precursor of invasive ductal carcinoma (IDC) 1 , 2 . Patients diagnosed with DCIS always have a favorable prognosis with a 20-year breast cancer-specific mortality rate of approximately 3.3% 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Carefully selecting eligible patients for watchful waiting and excluding those with an occult invasive component is critical. Meanwhile, pure DCIS has no potential of metastasis, thus lymph node staging at surgery is not routinely indicated 2 , 7 . But for patients with a pathological underestimation, re-operation for axillary status evaluation is required.…”

Section: Introductionmentioning

confidence: 99%

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Pathological underestimation and biomarkers concordance rates in breast cancer patients diagnosed with ductal carcinoma in situ at preoperative biopsy

Zhou¹,

Xiao-dong³

et al. 2022

Sci Rep

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Ductal carcinoma in situ (DCIS) often upgrade to invasive breast cancer at surgery. The current study aimed to identify factors associated with pathological underestimation and evaluate concordance rates of biomarkers between biopsy and surgery. Patients diagnosed with DCIS at needle biopsy from 2009 to 2020 were retrospectively reviewed. Univariate and multivariate analyses were performed to identify factors associated with pathological underestimation. Concordance rates between paired biopsy samples and surgical specimens were evaluated. A total of 735 patients with pure DCIS at biopsy were included, and 392 patients (53.3%) underwent pathological underestimation at surgery. Multivariate analysis demonstrated that tumor size > 5.0 cm [odds ratio (OR) 1.79], MRI BI-RADS ≥ 5 categories (OR 2.03), and high nuclear grade (OR 2.01) were significantly associated with pathological underestimation. Concordance rates of ER, PR, HER2 status and Ki-67 between biopsy and surgery were 89.6%, 91.9%, 94.8%, and 76.4% in lesions without pathological underestimation, and were 86.4%, 93.2%, 98.2% and 76.3% for in situ components in lesions with pathological underestimation. Meanwhile, in situ components and invasive components at surgery had concordance rates of 92.9%, 93.8%, 97.4%, and 86.5% for those biomarkers, respectively. In conclusion, lesions diagnosed as DCIS at biopsy have a high rate of pathological underestimation, which was associated with larger tumor size, higher MRI BI-RADS category, and higher nuclear grade. High concordances were found in terms of ER, PR, and HER2 status evaluation between biopsy and surgery, regardless of the pathological underestimation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pathological underestimation and biomarkers concordance rates in breast cancer patients diagnosed with ductal carcinoma in situ at preoperative biopsy

Zhou¹,

Xiao-dong³

et al. 2022

Sci Rep

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“…Because of the fact that VABB is not covered by Chinese health insurance, considering the treatment cost, our center did not routinely resort to VABB in preoperative biopsy, which resulted in the lack of this part of data in our study. However, the most widely shared opinion is that VABB is also more accurate than CNB [5,6,21,25]. The reason may be that VABB and open biopsy can obtain more tissue specimens than CNB biopsy.…”

Section: Discussionmentioning

confidence: 99%

Is it feasible to selectively perform axillary lymph node surgery for patients with biopsy diagnosed Ductal Carcinoma in Situ? A study based on developed and validation of nomogram

Peng,

Wu,

Guo

et al. 2024

Preprint

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Purpose It is still unclear which patients diagnosed with DCIS through biopsy can benefit from lymph node surgery. We aimed to developed and validated a nomogram to predict the risk of upstaging to invasion, and explore the factors related to lymph node metastasis in biopsy diagnosis of DCIS patients. Methods A retrospective study was conducted on 526 cases diagnosed with DCIS before surgery in the period of January 2016 to December 2022. Nomograms for predicting the probability of invasion disease were constructed according to multivariate logistic regression analysis. This nomogram was validated using a second data set of 133 patients between January to December 2023. Univariate and multivariate analysis were used to evaluate the risk factors for lymph node metastasis. Results Underestimating invasive carcinoma occurred in 42.0% of patients, of whom 37 had positive lymph node. Core needle biopsy, mass on mammography, moderate nuclear grade of DCIS and increased Ki-67 expression were associated with upstaging. Nomogram developed depending on these factors showed acceptable performance on predicting upstaging (AUC 0.724). This nomogram was validated in a second dataset with an AUC of 0.641. calcification on mammography, mass on MRI performance and large radiological size were independent risk factors of lymph node metastasis. Conclusion Underestimating invasive carcinoma with DCIS detected prior to surgery is common, but with a low probability of lymph node metastasis. This nomogram and factors associated with positive lymph node may provide help in selecting suitable patients for axillary lymph node excision.

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“…Changes in the analysis of LN using serial sections coupled with cytokeratin immunodetection by IHC has increased ITC and micrometastases identification. Depending on the studies, SLN removal associated with exhaustive LN analysis has increased the incidence of LN involvement varying from 0.9% to 8% (49)(50)(51)(52)(53). In these studies, most of ALN involvements were limited to isolated or small clusters of epithelial cells (49).…”

Section: Slnb Indications and Contraindications In Case Of Ductal Carcinoma In Situ (Dcis)mentioning

confidence: 99%

“…In the future, SLNB in cases of DCIS treated by mastectomy could be reserved to particular clinical/ radiological presentations (clinical or radiological mass, extensive forms or multiple foci) and omitted in other cases. For some authors, the presence of a micropapillary form should also lead to a SLNB, because of the associated risk of invasive carcinoma (50).…”

Section: Slnb Indications and Contraindications In Case Of Ductal Carcinoma In Situ (Dcis)mentioning

confidence: 99%

Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions

Mathelin¹,

Lodi²

2021

Chin Clin Oncol

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The aim of this narrative review was to provide an update on the use of sentinel lymph node biopsy (SLNB) for breast carcinoma (BC). Relevant studies published between 01/01/1994 and 15/08/2020 assessing the accuracy and the usefulness of SLNB were reviewed. SLNB was first used in 1977 for penile cancers. However, it took 17 years to enter in clinical practice for BC. The first procedures were based on two methods of non-specific marking of LN vmacrophages using a radioisotope ( 99m Tc) and a blue dye (BD, Isosulfan, Patent or Methylene). To overcome side effects of radioisotopes (radiation exposure) and BD (allergic reactions), innovative tracers such as indocyanine green (ICG), superparamagnetic iron oxide (SPIO), and microbubbles have been explored. The SLN intraoperative examination is no longer performed, due to its low impact on the rate of reoperation and high time and cost of surgery. Likewise, immunohistochemistry, which can lead to an unnecessary ALND in some cases of occult metastases, is no more recommended.Except cases with metastasized LN, all contraindications aim to avoid situations where the risk of false negative would be too high (notably T3-T4 or multicentric tumors). The current indications for invasive BC are T0-T1-T2 N0 or N1 (after an accurate LN evaluation with ultrasound and/or cytology or core biopsy) and for DCIS treated by mastectomy or presenting as a palpable mass. After SLNB, axillary recurrence rates are generally below 2% after a follow up of 8-10 years, comparable to those observed after ALN. Likewise, when the SLN contains less than 2 metastases, axillary recurrence rates remain low even when ALN is omitted. In case of more than 2 metastatic SLN or capsular effraction, ALND is still indicated. For most teams, SLNB can be performed in clinically node-negative patients receiving neoadjuvant systemic therapy.The results of the literature consistently show that SLNB is extremely reliable in selected BC, as long as it is performed with a rigorous technique by teams having undergone multidisciplinary training and having gained the necessary experience.

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Does sentinel lymph node biopsy for screening high-grade ductal carcinoma in situ of the breast cause more harm than good?

Cited by 7 publications

References 30 publications

Pathological underestimation and biomarkers concordance rates in breast cancer patients diagnosed with ductal carcinoma in situ at preoperative biopsy

Pathological underestimation and biomarkers concordance rates in breast cancer patients diagnosed with ductal carcinoma in situ at preoperative biopsy

Is it feasible to selectively perform axillary lymph node surgery for patients with biopsy diagnosed Ductal Carcinoma in Situ? A study based on developed and validation of nomogram

Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions

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