Role of Axillary Staging in Women Diagnosed With Ductal Carcinoma In Situ With Microinvasion

Pimiento, José M.; Lee, M. Catherine; Esposito, Nicole N.; Kiluk, John V.; Khakpour, Nazanin; Carter, W. Bradford; Han, Gang; Laronga, Christine

doi:10.1200/jop.2010.000096

Cited by 29 publications

(20 citation statements)

References 18 publications

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“…Authors reporting a high incidence of positive sentinel lymph nodes argue in favor of sentinel lymph node biopsy in all patients with microinvasive carcinoma, 9,19,28,30,31 whereas authors reporting the low incidence of positive sentinel lymph nodes have questioned whether sentinel lymph node biopsy should be performed in all such patients. 32,[34][35][36][37][38] The wide variation in reported incidence can be explained in part by the diversity in the histopathologic definition of microinvasive carcinoma used in various reports. In 1982, Lagios et al, 40 Later, the 5th edition of the AJCC staging manual defined microinvasive carcinoma as extension of carcinoma cells beyond basement membrane with no single focus 41 mm, whereas Silver and Tavassoli 11 defined it as a single focus of invasive carcinoma p2 mm or up to three foci of invasion, each p1 mm in greatest dimension.…”

Section: Discussionmentioning

confidence: 95%

Re-evaluating the role of sentinel lymph node biopsy in microinvasive breast carcinoma

et al. 2014

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The role of sentinel lymph node biopsy in microinvasive breast carcinoma is unclear. We examined the incidence of lymph node metastasis in patients with microinvasive carcinoma who underwent surgery at our institution. Retrospective review of our pathology database was performed (1994-2012). Of 7000 patients surgically treated for invasive breast carcinoma, 99 (1%) were classified as microinvasive carcinoma. Axillary staging was performed in 81 patients (64, sentinel lymph node biopsy; 17, axillary lymph node excision). Seven cases (9%) showed isolated tumor/epithelial cells in sentinel nodes. Three of these seven cases showed reactive changes in lymph nodes, papillary lesions in the breast with or without displaced epithelial cells within biopsy site tract, or immunohistochemical (estrogen receptor, progesterone receptor, and HER2) discordance between the primary tumor in the breast and epithelial cells in the lymph node, consistent with iatrogenically transported epithelial cells rather than true metastasis. The remaining four cases included two cases, each with a single cytokeratin-positive cell in the subcapsular sinus detected by immunohistochemistry only, and two cases with isolated tumor cells singly and in small clusters (<20 cells per cross-section) by hematoxylin and eosin and immunohistochemistry. The exact nature of cytokeratin-positive cells in the former two cases could not be determined and might still have represented iatrogenically displaced cells. In the final analysis, only two cases (3%) had isolated tumor cells. Three of these four cases had additional axillary lymph nodes excised, which were all negative for tumor cells. At a median follow-up of 37 months (range 6-199 months), none of these patients had axillary recurrences. Our results show very low incidence of sentinel lymph node involvement (3%), only as isolated tumor cells, in microinvasive carcinoma patients. None of our cases showed micrometastases or macrometastasis. We recommend reassessment of the routine practice of sentinel lymph node biopsy in patients with microinvasive carcinoma.

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Section: Discussionmentioning

confidence: 95%

Re-evaluating the role of sentinel lymph node biopsy in microinvasive breast carcinoma

et al. 2014

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“…When comparing treatments of patients with DCISM in different national cancer centers, the data showed that there were less breast conserved surgery (BCS) performed in patients in Chinese cancer center than those in US patient large-volume centers (1.1% VS 47.8e68%) [20,26,27]. In addition, no significant difference of the overall survival rate between patients with DCIS and DCISM was observed after median 100 months follow-up (Fig.…”

Section: Resultsmentioning

confidence: 82%

The clinical features and management of women with ductal carcinoma in situ with microinvasion: A retrospective Cohort study

Zhang

Wei

et al. 2015

International Journal of Surgery

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“…According to this, DCIS comprises a spectrum from low-grade DCIS to high-grade disease with microinvasion (Badruddoja, 2012;Lee et al, 2012). Although DCIS is considered non-invasive, invasive components sometimes are detected in the lesion, recognized as DCIS with microinvasion when the invasive component is less than 1 millimeters in its largest diameter (Pimiento et al, 2011); these are unusual in lesions smaller than 2.5 cm (Siziopikou, 2013) and constitute 10-20% of all cases (Zhang et al, 2012). Transformation of in situ ductal lesions to invasive forms occurs more frequently and sooner in high grade and comedo lesions, local invasive recurrence is also more common in these (Estevez et al, 2010;Sorum et al, 2010;Patani et al, 2011).…”

Section: 2771 Change Of Ductal Carcinoma In Situ Of the Breast Over mentioning

confidence: 99%

“…The necessity of SND in cases of DCIS harboring microinvasion is controversial. Pimiento et al (2011) reviewed 87 cases of DCIS with microinvasion in their institution and found no risk factor for lymphatic invasion such as palpable mass, higher grades or comedonecrosis. Nevertheless, these researchers propose the use of SND in all cases of microinvasion accompanying DCIS (Pimiento et al, 2011).…”

Section: 2771 Change Of Ductal Carcinoma In Situ Of the Breast Over mentioning

confidence: 99%

“…Pimiento et al (2011) reviewed 87 cases of DCIS with microinvasion in their institution and found no risk factor for lymphatic invasion such as palpable mass, higher grades or comedonecrosis. Nevertheless, these researchers propose the use of SND in all cases of microinvasion accompanying DCIS (Pimiento et al, 2011). On the contrary, Parikh et al do not confirm the need to use any additional treatment modality further than standard surgery in these patients (Parikh et al, 2012).…”

Section: 2771 Change Of Ductal Carcinoma In Situ Of the Breast Over mentioning

confidence: 99%

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

Omranipour

Alipour²,

Hadji³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Breast cancer screening and higher quality mammography have resulted in an increase in the diagnosis of ductal carcinoma in situ worldwide. We compared the incidence and other factors in our cases of ductal carcinoma in situ between two recent decades. Ratio of ductal carcinoma in situ to overall breast cancer was 1.27 and 3.93 in phases 1 and 2, respectively. Rates of excisional or incisional biopsies versus core needle biopsies and clinically versus mammographically detected cases as well as median size of tumors dropped between the 2 phases while a substantial rise in the number of patients attending for screening was seen in this time period. Surgical treatments followed a trend from modified radical mastectomy and axillary lymphatic dissection toward breast conserving surgery and sentinel node dissection or no axillary intervention. Conclusions: Our study shows a considerable trend toward earlier detection of breast cancer and evolution of treatment strategies toward standard less invasive surgery of DCIS in Iran.

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Role of Axillary Staging in Women Diagnosed With Ductal Carcinoma In Situ With Microinvasion

Abstract: Background: Axillary staging via sentinel node biopsy (SLNB)

Cited by 29 publications

References 18 publications

Re-evaluating the role of sentinel lymph node biopsy in microinvasive breast carcinoma

Re-evaluating the role of sentinel lymph node biopsy in microinvasive breast carcinoma

The clinical features and management of women with ductal carcinoma in situ with microinvasion: A retrospective Cohort study

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

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