Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast

Zavagno, G.; Carcoforo, Paolo; Marconato, R.; Franchini, Zeno; Scalco, G.; Burelli, Paolo; Pietrarota, Paolo; Lise, Mario; Mencarelli, Roberto; Capitanio, Giovanni; Ballarin, Andrea; Pierobon, M.; Marconato, Giorgia; Nitti, Donato

doi:10.1186/1471-2407-5-28

Cited by 54 publications

(34 citation statements)

References 22 publications

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“…Advocates of SLN biopsy in DCIS at the time of excision suggest that SLN biopsy may not be reliable after tumour excision and that patients should undergo an axillary lymph node dissection if a SLN biopsy was not performed at the time of the first operation 52 . However, others argue that SLN biopsy can be performed Reference Cserni 39 Kelly et al 20 Intra et al 21 Farkas et al 22 Veronesi et al 40 Zavagno et al 23 Katz et al 30 Mabry et al 15 Leidenius et al 41 Sakr et al 42 Di Saverio et al 43 Overall 0·100 0·023 0·031 0·011 0·018 0·020 0·073 0·059 0·068 0·103 0·125 0·037 0·005 0·050 0·500…”

Section: Discussionmentioning

confidence: 96%

“…Patients with a preoperative diagnosis of DCIS who need a mastectomy or a wide excision close to the axilla 15,23 should, therefore, undergo a concomitant SLN biopsy. SLN biopsy in high-risk patients with DCIS has also been advocated as a tool for discovering invasive cancers with metastatic potential, which might be missed on routine histological examination of the primary tumour 39,55,56 .…”

Section: Discussionmentioning

confidence: 99%

“…Rate of SLN positivity as a second procedure after lumpectomy 53,54 , but not after mastectomy or a wide quadrantectomy of the upper outer quadrant, which will disrupt lymphatic pathways toward the axilla 15,23 . Patients with a preoperative diagnosis of DCIS who need a mastectomy or a wide excision close to the axilla 15,23 should, therefore, undergo a concomitant SLN biopsy.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Ansari

Ogston

Purdie

et al. 2008

British Journal of Surgery

102

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Ansari

Ogston

Purdie

et al. 2008

British Journal of Surgery

102

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“…11 On the other hand, a previous study 5 assimilated well-differentiated low-grade micropapillary ductal carcinoma in situ to 'clinging' carcinomas and suggested that excision without additional irradiation may be offered to the patients, considering the exceptionally low risk of recurrences of these in situ cancers; whereas other studies on the role of sentinel nodes in ductal carcinoma in situ have shown that micrometastases were regularly associated to non-high grade micropapillary in situ variant. [23][24][25][26] Taking all these data together, we collected a series of micropapillary ductal carcinoma in situ with the aim to evaluate the biological and clinical significance of this growth pattern.…”

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confidence: 99%

Micropapillary ductal carcinoma in situ of the breast: an inter-institutional study

et al. 2010

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The clinical significance of micropapillary growth pattern in ductal carcinoma in situ is controversial and the impact of nuclear grading in terms of recurrence of this lesion is yet to be clarified. Our aim was to evaluate, on a series of micropapillary in situ carcinomas, the histological features correlated with recurrence and whether the micropapillary subtype had a different behavior from other non-micropapillary ductal carcinoma in situ. We collected 55 cases of micropapillary in situ carcinomas from four institutions. All cases were reviewed for nuclear grade, extent, necrosis, microinvasion and tested for estrogen and progesterone receptors, Ki67, HER2, EGFR and p53 expression. Clinical data, type of surgery and follow up were obtained for all patients. Our results showed that the nuclear grade is crucial in determining the biology of micropapillary carcinoma in situ, so that the high nuclear grade micropapillary ductal carcinoma in situ more frequently overexpressed HER2, showed higher proliferation index, displayed necrosis and microinvasion and was more extensive than low/intermediate nuclear grade. Logistic regression analysis confirmed the high nuclear grade (Odds ratio: 6.86; CI: 1.40-33.57) as the only parameter associated with elevated risk of local recurrence after breast-conserving surgery. However, the recurrence rate of 19 micropapillary carcinoma in situ, which were part of a cohort of 338 consecutive ductal carcinoma in situ, was significantly higher (log-rank test, P-value ¼ 0.019) than that of non-micropapillary, independently of the nuclear grade. In conclusion, although nuclear grade may significantly influence the biological behavior of micropapillary ductal carcinoma in situ, micropapillary growth pattern per se represents a risk factor for local recurrence after breast-conserving surgery.

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“…We would recommend the use of the GWL technique in cases with extensive microcalcifications and when SLNB is not going to be performed (pure DCIS, radial scar, etc.) [32,33].…”

Section: Discussionmentioning

confidence: 99%

Change of attitude in the surgical treatment of early breast cancer

Takács

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The purpose of this study was to compare the two methods-guidewire localisation and the radioguided occult lesion localisation-used in the localisation and surgical removal of non-palpable breast tumours. This retrospective study enrolled patients diagnosed with nonpalpable malignant breast tumours. In this study either guidewire localisation (GWL, n 069) or radioguided occult lesion localisation (ROLL, n0321) was used for the detection and removal of the tumours. The two methods were compared with regards to preoperative localisation time, operating time, removed specimen volume, the pathological tumour size, the presence of positive surgical margins and postoperative complications. Furthermore, we have also investigated other factors that could have an impact on the frequency of positive resection margins. The localisation time was significantly shorter in the ROLL group, both with ultrasound guidance (5.7±1.44 min vs. 21.6±2.37 min, p00.05) and with radiographic guidance (21.8±3.1 min vs. 41.6±3.75 min, p00.021) as well. No significant difference was observed between the two methods in terms of operating time, removed specimen volume and pathological tumour size, or the presence of positive resection margins, or the occurrence of postoperative wound infections. The size of the tumour (ROLL, GWL grps), the presence of a multifocal tumour (ROLL grp), the presence of an extensive in situ breast carcinoma around the invasive cancer (ROLL, GWL grps) and the volume of the removed breast specimen (GWL grp) significantly increased the frequency of positive resection margins. We recommend the use of the ROLL method for the removal of nonpalpable breast tumours as it has a much shorter localisation time, and it is a simpler surgical technique as well.

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Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast

Cited by 54 publications

References 22 publications

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Meta-analysis of sentinel node biopsy in ductal carcinomain situof the breast

Micropapillary ductal carcinoma in situ of the breast: an inter-institutional study

Change of attitude in the surgical treatment of early breast cancer

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