Sentinel lymph node biopsy is not necessary in patients diagnosed with ductal carcinoma in situ of the breast by stereotactic vacuum-assisted biopsy

Kotani, Hirokazu; Yoshimura, Akinobu; Adachi, Yayoi; Ishiguro, Junko; Hisada, Tomoka; Ichikawa, Mari; Gondou, Naomi; Hattori, Masao; Kondou, N.; Sawaki, Masataka; Fujita, Takashi; Iwata, Hiroji

doi:10.1007/s12282-014-0546-y

Cited by 19 publications

(8 citation statements)

References 27 publications

(26 reference statements)

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“…In our study, the rate of SLN positivity among these upstaged patients was small but clinically significant (10%). Previous studies have reported a similar rate of 4%‐15% SLN positivity among patients with DCIS upstaged to invasive cancer . Among patients with a final diagnosis of DCIS on mastectomy, there were no cases of SLN involvement.…”

Section: Resultssupporting

confidence: 56%

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Sentinel lymph node positivity in patients undergoing mastectomies for ductal carcinoma in situ (DCIS)

et al. 2020

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Breast J. 2020;26:931-936. wileyonlinelibrary.com/journal/tbj | 931 Abstract Current guidelines recommend sentinel lymph node biopsy (SLNB) for patients undergoing mastectomy for a preoperative diagnosis of ductal carcinoma in situ (DCIS). We examined the factors associated with sentinel lymph node positivity for patients undergoing mastectomy for a diagnosis of DCIS on preoperative core biopsy (PCB). The Institutional Breast Cancer Database was queried for patients with PCB demonstrating pure DCIS followed by mastectomy and SLNB from 2010 to 2018. Patients were divided according to final pathology (DCIS or invasive cancer). Clinicopathologic variables were analyzed using Pearson's chi-squared, Wilcoxon Rank-Sum and logistic regression. Of 3145 patients, 168(5%) had pure DCIS on PCB and underwent mastectomy with SLNB. On final mastectomy pathology, 120(71%) patients had DCIS with 0 positive sentinel lymph nodes (PSLNs) and 48(29%) patients had invasive carcinoma with 5(10%) cases of ≥1 PSLNs. Factors positively associated withupstaging to invasive cancer in univariate analysis included age (P = .0289), palpability (P < .0001), extent of disease on imaging (P = .0121), mass on preoperative imaging (P = .0003), multifocality (P = .0231) and multicentricity (P = .0395). In multivariate analysis, palpability (P = .0080), extent of disease on imaging (P = .0074) and mass on preoperative imaging (P = .0245) remained significant (Table 2). In a subset of patients undergoing mastectomy for DCIS with limited disease on preoperative evaluation, SLNB may be omitted as the risk of upstaging is low. However, patients who present with clinical findings of palpability, large extent of disease on imaging and mass on preoperative imaging have a meaningful risk of upstaging to invasive cancer, and SLNB remains important for management. K E Y W O R D S core biopsy, ductal carcinoma in situ, invasive carcinoma, sentinel lymph node biopsy, total mastectomy, upgrade rate

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Section: Resultssupporting

confidence: 56%

“…DCIS diagnosed on PCB is upstaged to invasive disease on final surgical pathology at a rate of 8%‐40% . When DCIS is upstaged to invasive disease, the rate of SLN positivity is reported in the literature as 4%‐15% …”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node positivity in patients undergoing mastectomies for ductal carcinoma in situ (DCIS)

et al. 2020

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“…Notably, the proportion of SLN metastasis in DCIS patients undergoing SLN biopsy during breast surgery (breast conserving surgery or mastectomy) is reported to be 0.6-13.4% (6,8,(11)(12)(13)(14)(15)(16)(17). Given the low positivity and the potential harms the SLN procedure may cause, the role of SLN biopsy in most DCIS patients has been controversial in recent years (18).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…For our above described collective without stratification of lesion size or nuclear grade, the risk of underestimation of invasion did not exceed 10 % so that a general recommendation of a sentinel lymph node biopsy in combination with a breast-conserving biopsy in terms of a DCIS diagnosis and sonographicaly normal axillary lymph nodes does not seem adequate. Kotani et al concluded that because of a low prevalence of metastatic involvement, the cessation of SLNB is a reasonable consideration in patients initially diagnosed with DCIS by stereotactic VAB [14]. In concordance, the American Society of Clinical Oncology recently updated a clinical practice guideline and recommends that women with DCIS should not undergo SLNB when breast-conserving surgery is planned [12].…”

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confidence: 99%

Rates of presurgical underestimation of breast cancer after standardized assessment of breast calcifications

Timpe

Berkemeyer

Puesken

et al. 2015

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Purpose: To determine the frequency of histopathological underestimation of breast cancer after vacuum-assisted biopsy (VAB) in standardized assessment of breast calcifications compared to postsurgical diagnosis. Materials and methods: The retrospective study included acquired data of 506 consecutively examined women, who underwent VAB for the assessment of pure calcifications after standardized digital mammographic and sonographic imaging. 119/506 (24.5?%) women underwent further surgical procedures: 37 women had a surgical diagnostic excision biopsy, 82 women a surgical procedure based on a therapeutic concept. Presurgical results of VAB were compared with the postsurgical histopathological reports. Results: In 91/119 women (76.5?%) the final histology was malignant. The rate of ductal carcinoma in situ (DCIS) was 79.1?% (72/91) and the rate of invasive carcinoma was 20.9?% (19/91). In 9/37 women with diagnostic excision biopsy, the presurgical status of benign or uncertain changed to a postsurgical diagnosis of malignant (24.3?%). In?eight cases underestimation included DCIS (21.6?%) and in one case invasive cancer (2.7?%). Seven of the nine underestimated cases (77.8?%) resulted from excision biopsy of atypical epithelial proliferation of ductal type (AEPDT, positive predictive value 30.4?% (7/23)). After surgery due to DCIS in 7/71 women invasive breast cancer was diagnosed (9.9?%). In 11/82 women with oncological surgery, invasive cancer was already diagnosed by VAB. Conclusion: Underestimation of invasive cancer in terms of presurgical DCIS diagnosis can be minimized by the standardized assessment protocol to about 10?%. Underestimation of DCIS is mainly related to presurgical diagnosis of AEPDT. Key points:

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Sentinel lymph node biopsy is not necessary in patients diagnosed with ductal carcinoma in situ of the breast by stereotactic vacuum-assisted biopsy

Cited by 19 publications

References 27 publications

Sentinel lymph node positivity in patients undergoing mastectomies for ductal carcinoma in situ (DCIS)

Sentinel lymph node positivity in patients undergoing mastectomies for ductal carcinoma in situ (DCIS)

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

Rates of presurgical underestimation of breast cancer after standardized assessment of breast calcifications

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