Prediction of Sentinel Lymph Node Metastasis in Breast Ductal Carcinoma In Situ Diagnosed by Preoperative Core Needle Biopsy

Abstract

Purpose The positivity of sentinel lymph node (SLN) metastasis is relatively low in ductal carcinoma in situ (DCIS) patients. The aim of this study was to investigate factors associated with SLN metastasis and build a model to predict the potential risk of SLN metastasis in patients with a preoperative diagnosis of DCIS. Patients and Methods Core needle biopsy-proved DCIS patients who underwent SLN biopsy and breast surgery were retrospectively reviewed and selected. Univariate analysis was used to identify the variables correlated with SLN metastasis. A model to predict SLN metastasis was developed using a multivariate logistic regression in the training set and then validated in an internal set. Results A total of 407 patients with a preoperative diagnosis of DCIS were included. Upstaging to invasive/microinvasive cancer occurred in 225 patients after surgery. SLN metastasis was found in 42 patients, including 32 patients upstaging to invasive disease, 8 to microinvasive disease, and 2 pure DCIS. Tumor size based on US examination, axillary ultrasound finding, multifocality, surgery, upstaging, and Ki-67 expression were significantly related to SLN metastasis. The model incorporating tumor size, axillary ultrasound finding and multifocality yielded an AUC of 0.805 (95% CI: 0.715–0.895, p <0.001) in the training set, and 0.729 (95% CI: 0.547–0.911, p =0.013) in the testing set. Conclusion A simple model was developed to predict SLN metastasis in patients with a preoperative diagnosis of DCIS. With good discriminatory power, this model should be helpful for surgeons to decide if SLN biopsy could be safely avoided in certain patients.

Predictors of Sentinel Lymph Node Metastasis in Postoperatively Upgraded Invasive Breast Carcinoma Patients

“…The overall underestimation rate of DCIS patients by preoperative CNB was 26.5% (329/1240) in our cohort, which was comparable to the 25.9% reported in a previous metaanalysis study containing 7350 cases [3]. In the entire study population of 316 patients with underestimated IBC diagnosed by imaged-guided CNB, the incidence of SLN metastasis was 7.3%, which is within the reported incidence ranging from 0.9-15.6% [7][8][9][10][11][12][13][14] in patients with preoperative DCIS. It is noteworthy that, unlike previous study objects, which were involved in many pure DCIS, our study objects were relatively uniform and only focused on upgrading to IBC postoperatively.…”

“…Many prior studies have attempted to identify the risk factors for SLN metastasis in patients with preoperative DCIS [7,9,12,14]. Several factors related to clinical characteristics, including young age at diagnosis, palpability, and multifocality, have been demonstrated to be associated with SLN metastasis, but none of them showed a consistent impact on positive SLN among those studies.…”

“…For the diagnosis of lymph node stage in patients with early breast cancer and clinically negative axillary lymph nodes (ALNs), traditional ALN dissection [4][5][6] has been replaced by sentinel lymph node biopsy (SLNB) owing to its comparable accuracy, relative safety, and fewer complications. The reported incidence of sentinel lymph node (SLN) metastasis in patients with preoperative DCIS ranges from 0.9-15.6% [7][8][9][10][11][12][13][14]. Although several studies have analyzed the risk factors for subsequent SLN metastasis in patients with preoperative DCIS [7,9,12,14], no other clinicopathological findings or radiological features except for the IBC finding on final pathology, which was consistently confirmed as a factor related to SLN metastasis, were consistently identified by those studies.…”

“…The reported incidence of sentinel lymph node (SLN) metastasis in patients with preoperative DCIS ranges from 0.9-15.6% [7][8][9][10][11][12][13][14]. Although several studies have analyzed the risk factors for subsequent SLN metastasis in patients with preoperative DCIS [7,9,12,14], no other clinicopathological findings or radiological features except for the IBC finding on final pathology, which was consistently confirmed as a factor related to SLN metastasis, were consistently identified by those studies.…”

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

“…However, due to sampling errors, preoperative biopsy diagnosis of DCIS may underestimate the invasive lesions after nal surgical pathology. In recent reports, 14.1 to 53.3% of DCIS patients diagnosed by preoperative biopsy were upstaged to invasive cancer [4][5][6][7][8][9][10]. These studies also…”