Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy

Abstract

DCIS diagnosed by preoperative needle biopsy has a high probability of underestimation, and 15% of invasive cancer patients have node metastasis. SLNB may be justified in DCIS patients undergoing needle biopsies, and caution should be exercised in omitting SLNB in patients with one or no risk predictors.

Utilization of Axillary Surgery for Patients With Ductal Carcinoma In Situ: A Report From the National Cancer Data Base

“…The NCDB lacks information on the size and type of biopsy needle used, the number of biopsy samples, and comedo-necrosis, additional features associated with upstaging of DCIS. 12,[32][33][34][35] However, comparing our findings with the criteria in the NCCN and ASCO guidelines, ER status and grade are notable features missing from current recommendations. In our study, ER negativity was associated with both tumor upstaging and SLNB, and perhaps should be considered in future guidelines as an additional indication for SLNB in the treatment of lumpectomy patients with DCIS.…”

“…[5][6][7][8][9][10][11] Factors predictive of upstaging include palpability, a mammographic mass, larger size, multicentric disease, suspicion of microinvasion, high nuclear grade, necrosis, and use of smaller-gauge biopsy needles. 4,10,12,13 Reported rates for performance of SLNB for DCIS range from 21 to 97 %, but these rates are reported primarily from single-institution studies examining predictors of SLNB positivity, which select for tumors with high-risk characteristics. 6,[14][15][16] In 2010, the rate was 17.8 % for lumpectomy patients and 67.1 % for mastectomy patients in the Surveillance, Epidemiology, and End Results (SEER) database, although this was based on the number of lymph nodes examined rather than the specific type of axillary surgery.…”

Two Decades of Experience with Ductal Carcinoma in Situ of the Breast in the Cancer Institute of Tehran, Iran

“…If the surgical approach consisted of MAST, then sentinel node dissection (SND) is warranted at the same time, because in case invasive disease would be seen in the specimen, then SND would be impossible after MAST. Second, some suggest that when the histology represents high-risk disease (comedonecrosis or high grade disease), or in the presence of a clinical mass, SND should be done at the time of BCS (Schneider et al, 2010;Patani et al, 2011;Usmani et al, 2011;Badruddoja, 2012;Lee et al, 2012;Park et al, 2013;Siziopikou, 2013). The necessity of SND in cases of DCIS harboring microinvasion is controversial.…”

The Utility of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Suspicious for Microinvasion on Core Biopsy

“…[8][9][10] Additional characteristics associated with a higher risk of identifying invasive breast cancer and subsequent nodal disease in the setting of DCIS include a palpable mass, multicentric disease, high nuclear grade, necrosis, use of smaller-gauge biopsy needles, and a core needle biopsy (CNB) reported as DCIS with findings of Smic. [10][11][12] The rate of upstaging can be as high as 91 % for invasive cancer in patients with four high-risk characteristics on CNB. 11 Furthermore, DCIS with one high-risk characteristic has been associated with a 12 % rate of sentinel lymph node (SLN) involvement, although over three-quarters of those were micrometastases.…”

“…[10][11][12] The rate of upstaging can be as high as 91 % for invasive cancer in patients with four high-risk characteristics on CNB. 11 Furthermore, DCIS with one high-risk characteristic has been associated with a 12 % rate of sentinel lymph node (SLN) involvement, although over three-quarters of those were micrometastases. 1 Whether a CNB reported as Smic is a clinically significant risk factor for nodal disease and warrants SLNB is uncertain.…”