Indication for sentinel lymph node biopsy for breast cancer when core biopsy shows ductal carcinoma in situ

Miyake, Tomohiro; Shimazu, Kenzo; Ôhashi, Hiroshi; Taguchi, Tetsuya; Ueda, Shinsuke; Nakayama, Takahiro; Kim, Seung Jin; Aozasa, Katsuyuki; Tamaki, Yasuhiro; Noguchi, Shinzaburo

doi:10.1016/j.amjsurg.2010.09.032

Cited by 40 publications

(36 citation statements)

References 36 publications

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“…Therefore the total histologic underestimation rate of invasive disease was 33%. This is similar to other published studies (8.8%-51.5%) [3] . However, this high rate should not be used as an argument favoring the routine use of SLNB because it will expose about 67% of our patients to an unnecessary SLNB.…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcissupporting

confidence: 82%

“…The reported rate of underestimation of invasive disease following a CNB diagnosis of pure DCIS varies among different institutions (8.8%-51.5%) [3] . This wide range reflects the different methods used for core biopsy, pathological assessment, and different patient populations.…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

“…First, the reported high incidence of SLN metastasis (0.39%-20%) in DCIS [4,5] . Second, the reported high rate of underestimation (8.8%-51.5%) associated with CNB [3] . Third, SLN metastasis is an indirect method of diagnosing occult invasive disease that may be missed on routine postoperative examination of the final specimen [17] .…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

“…that varies between 8.8% and 51% [3] . There are two problems associated with the diagnosis of pure DCIS.…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

“…Therefore, the diagnosis is more definitive. About 8.8%-51.5% of pure DCIS diagnosed by CNB are upstaged to DCIS with microinvasion (DCIS-MI) or invasive disease on final pathology [3] . Thus, it is of value to stage the axilla in patients diagnosed with pure DCIS by a CNB.…”

Section: Introductionmentioning

confidence: 99%

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Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Alameer¹,

Nefaie²,

Johani³

et al. 2016

WJCO

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AIM:To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) Al-Ameer AY et al . SNLB in clinically detected DCIS of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy. Core tip: While most ductal carcinoma in situ (DCIS) cases present with a radiologically detected abnormality, our sample represented a rare group of ductal carcinoma which was detected clinically. This study had a specific objective to determine the indications for sentinel lymph node in clinically detected DCIS. There are very few studies worldwide tracking this specific group, and there is no screening program in our community for breast cancer. This study will help communities who have no screening program to put protocols in place for such a specific group of patients.

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Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcissupporting

confidence: 82%

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

“…that varies between 8.8% and 51% [3] . There are two problems associated with the diagnosis of pure DCIS.…”

Section: Al-ameer Ay Et Al Snlb In Clinically Detected Dcismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Alameer¹,

Nefaie²,

Johani³

et al. 2016

WJCO

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Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast

Lee

Yang

Woo

et al. 2013

British Journal of Surgery

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Trends and clinicopathological predictors of axillary evaluation in ductal carcinoma in situ patients treated with breast‐conserving therapy

Huang

Yang

et al. 2017

Cancer Medicine

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The aim of this study was to investigate the trends of axillary lymph node evaluation in ductal carcinoma in situ (DCIS) patients treated with breast‐conserving therapy (BCT) and to identify the clinicopathological predictors of axillary evaluation. DCIS patients treated with BCT in 2006–2015 at our institute were retrospectively included in the analysis. Patients were categorized into three groups: sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), and non‐evaluation. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted axillary evaluation. A total of 315 patients were identified, among whom 135 underwent SLNB, and 15 underwent ALND. The proportion of patients who underwent axillary evaluation increased from 33.0% in 2006–2010 to 53.8% in 2011–2015 (P < 0.001), however, no patients had lymph node metastasis based on final pathology. In multivariate analysis, high‐grade tumor favored axillary evaluation (OR = 4.376, 95% CI:1.410–13.586, P = 0.011); while excision biopsy favored no axillary evaluation compared with other biopsy methods (OR = 0.418, 95% CI: 0.192–0.909, P = 0.028). Subgroup analysis of patients treated in 2011–2015 revealed that high‐grade tumor (OR = 5.898, 95% CI: 1.626–21.390, P = 0.007) and palpable breast lump (OR = 2.497, 95% CI: 1.037–6.011, P = 0.041) were independent predictors of axillary lymph node evaluation. Despite the significant decrease in ALND and a concerning overuse of SLNB, we identified no axillary lymph node metastasis, which justified omitting axillary evaluation in these patients. High‐grade tumor, palpable lump, and biopsy method were independent predictors of axillary evaluations. Excision biopsy of suspicious DCIS lesions may potentially preclude the invasive component of the disease and help to avoid axillary surgery

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Indication for sentinel lymph node biopsy for breast cancer when core biopsy shows ductal carcinoma in situ

Cited by 40 publications

References 36 publications

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Sentinel lymph node biopsy in clinically detected ductal carcinomain situ

Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast

Trends and clinicopathological predictors of axillary evaluation in ductal carcinoma in situ patients treated with breast‐conserving therapy

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