Sentinel lymph node biopsy in microinvasive ductal carcinomain situ

Abstract

Background: Microinvasive breast cancer is an uncommon pathological entity. Owing to the rarity of this condition, its surgical axillary management and overall prognosis remain controversial.Methods: A database was analysed to identify patients with microinvasive ductal carcinoma in situ (DCIS) who had surgery for invasive breast cancer at the European Institute of Oncology, Milan, between 1998 and 2010. Women who had undergone axillary staging by sentinel lymph node biopsy were included in the study.Results: Of 257 women with microinvasive breast cancer who underwent sentinel lymph node biopsy (SLNB), 226 (87⋅9 per cent) had negative sentinel lymph nodes (SLNs) and 31 had metastatic SLNs. Twelve patients had isolated tumour cells (ITCs), 14 had micrometastases and five had macrometastases in sentinel nodes. Axillary lymph node dissection was performed in 16 of the 31 patients with positive SLNs. After a median follow-up of 11 years, only one regional first event was observed in the 15 patients with positive SLNs who did not undergo axillary lymph node dissection. There were no regional first events in the 16 patients with positive SLNs who had axillary dissection.Conclusion: Good disease-free and overall survival were found in women with positive SLNs and microinvasive DCIS. This study is in line with studies showing that SLNB in microinvasive DCIS may not be useful, and supports the evidence that less surgery can provide the same level of overall survival with better quality of life.Snapshots in Surgery: to view submission guidelines, submit your snapshot and view the archive, please visit www.bjs.co.uk placed via the suprapubic trocar at the end of surgery. After operation, the urinary catheter bag was found to be filled Snapshot quiz

Axillary surgery in breast cancer: An updated historical perspective

“…Furthermore, a small rate of SLN metastases in microinvasive BC (2.9%) was also described by Fan et al, who studied a wide cohort from a National Cancer Database [55] . Indeed, these observations are supported by Level 1 evidence underlining that axillary dissection may be avoided in SLN-positive breast cancer patients undergoing BCS with radiotherapy when there is a low axillary metastatic burden (Z0011) [52] . As outlined through this historical perspective, the common thread from the past that weaves its way through the present and stretches toward the future is the progressive tendency to reduce the extension of axillary lymph-node surgery in breast cancer management ( Figs.…”

“…In the future, could we consider a potential omission of SLNB in selected cases of MIC? The incidence of axillary metastasis in sentinel nodes in MIC varies in studies from approximately 2% to 20% [52] . In a recent retrospective study from the European Institute of Oncology, that analyzed 257 women with microinvasive breast cancer who underwent SLNB, the reported incidence of axillary metastasis was 12.1%, slightly higher than previously reported [53] , and which falls within the range described in the published medical literature [52] .…”

“…The incidence of axillary metastasis in sentinel nodes in MIC varies in studies from approximately 2% to 20% [52] . In a recent retrospective study from the European Institute of Oncology, that analyzed 257 women with microinvasive breast cancer who underwent SLNB, the reported incidence of axillary metastasis was 12.1%, slightly higher than previously reported [53] , and which falls within the range described in the published medical literature [52] . The low rate of macrometastases (1.9%) with good overall survival and disease-free survival, suggests that SLNB may not be useful in MIC, owing to the small risk of lymph node metastasis and good prognosis.…”

Clinical characteristics of breast ductal carcinoma in situ with microinvasion: a narrative review

“…Patients with negative SLNB do not require further surgical management of the axilla. However, in a recent study investigating the role of SLNB in DCIS-MI, Magnoni and colleagues 33 found that SLNB was not a good predictor of the need for ALND. Among 257 women with microinvasive breast cancer, 87.9% (266) had negative SLNB, and 12.1% (31) had positive SLNB.…”

Trends in diagnostic confirmation and treatment of pre-malignant abnormalities at screening mammography

“…[51][52][53] Even if the SLN is found positive in patients with a preoperative diagnosis of DCIS, it is most frequently reported to present as micrometastases (defined as small metastases sized 0.2-2.0 mm), which are of limited clinical value in this respect. 54,55 Nowadays, a delayed SLNB following lumpectomy if invasive cancer is shown, is considered a feasible option. Therefore, we agree with a recent study by Van Roozendaal et al who suggest omitting SLNB completely in patients with DCIS undergoing BCS.…”