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

Price, Alison; Schnabel, Freya; Chun, Jennifer; Kaplowitz, Elianna; Goodgal, Jenny; Guth, Amber; Axelrod, Deborah; Shapiro, Richard L.; Mema, Eralda; Moy, Linda; Darvishian, Farbod; Roses, Daniel F.

doi:10.1111/tbj.13737

Cited by 19 publications

(18 citation statements)

References 27 publications

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“…100% of sentinel lymph nodes were found by using the lymphoscintigraphy and dual technique, and a 10% (n = 4) positivity of the sentinel node. [16,17]. Van Roozendaal et al in the Netherlands also reported 9.3% sentinel node positivity, with 3.8% positivity with isolated cells, 3% micrometastasis, and 2.5% macrometastasis, results similar to those of our study [10].…”

Section: Discussionsupporting

confidence: 91%

When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center

Casas

Muñoz

Gómez

et al. 2021

Cureus

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IntroductionDuctal carcinoma in situ (DCIS) accounts for 15% of breast cancers. Surgery is the main treatment, and the use of sentinel node biopsy (SLNB) is restricted to patients at risk of infiltration, which is estimated to be around 26%. Materials and methodsAimed at evaluating the benefit of SLNB in patients with DCIS at the Breast and Soft Tissue Functional Unit of the National Cancer Institute (INC for its initials in Spanish), a descriptive observational study of a retrospective cases series was conducted between August 1, 2013, and September 30, 2018. ResultsA total of 40 patients with a median age of 57 years were included in the study; 62.5% of them underwent mastectomy with SLNB, and the remaining 37.5% underwent conservative surgery with SLNB. 100% of sentinel nodes were identified, by using lymphoscintigraphy in 95%. Sentinel node was positive in four patients (10%), three of whom had infiltration in the surgical specimen reported. With a follow-up of 49 months, only one patient had a local relapse. None of the patients had axillary or distant recurrence. ConclusionsSLNB in DCIS should be limited to patients with risk factors for infiltration (tumor size greater than 3 cm, comedo-type histology, and high-grade DCIS), and patients with an indication for mastectomy. Its percentage of complications is low, and a high identification percentage in surgical groups with adequate training.

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Section: Discussionsupporting

confidence: 91%

When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center

Casas

Muñoz

Gómez

et al. 2021

Cureus

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“…In the current study, we enrolled 682 pre-OP DCIS patients and compared ALN metastasis pattern with another cohort of 2268 pre-OP diagnosed invasive cancer. We found 34.2% of these pre-OP DCIS patients upgraded to DCIS-IC in nal pathology, and this upgrade rate was consistent with literate reported range (3.5-56%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The risk of ALN metastasis rate varied widely depends on the pre-operative pathology, and in our current study, the ALN metastasis rate is 7.6% in pre-OP DCIS patients, and up to 39% in pre-OP invasive cancer group (Table 2).…”

Section: Discussionsupporting

confidence: 88%

“…In theory, ductal carcinoma in situ (DCIS) does not metastasize to adjacent lymph nodes, and axillary lymph node evaluation or surgery had limited role. DCIS as determined by pathologic analysis of biopsy specimens, however, does not preclude invasive disease in excised specimens, and up to 50% (range, 3.5-56%) of core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) diagnosed DCIS would upgrade to have an invasive component (IC) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Indication and adequacy of application of SLNB in lymph node evaluation of patients with pre-operative (pre-OP) DCIS diagnosed by biopsy remained a debated issue as SLNB remains an invasive procedure and not morbidity free [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…Parallel with increasing early detection of breast cancer, DCIS rate increased up to 14% -20%, and around half (68% in current study) of them would receive mastectomy. This group of patients constituted about 5% of annual breast cancer cases, which constituted a non-ignorable minority[6]. Current practice guideline had suggested SLNB to be performed in pre-OP biopsy diagnosed DCIS and received mastectomy as secondary lymph node staging surgery seems unreliable when post-OP pathology upgrade to invasive breast cancer[31,32].In our 430 patients with pre-OP biopsy diagnosed DCIS received mastectomy, 59.3% remained DCIS-post-OP, and in these patients SLNB seemed unnecessary or "over-treatment".…”

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confidence: 99%

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Revisit the Practice of Lymph Node Biopsy in Patients Diagnosed as Ductal Carcinoma In Situ Before Operation: A Retrospective Analysis of 682 Cases and Evaluate the Role of Breast MRI

Lai

Chang

Chen

et al. 2021

Preprint

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Background: The optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients were evaluated. Methods: Patients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast MRI for ALN evaluation, predictors of breast & ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed.Results: A total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients received breast conserving surgery and 40.7% for mastectomy (p<0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node negative breast cancer patients with MRI tumor size < 3cm, the NPV was 96.4%, and all these false negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size <3 cm and node negative suitable for BCS could safety omit SLNB if whole breast radiotherapy is to be performed.Conclusion: Breast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference.

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“… 2 , 30 The number of surgeons who have discontinued the use of SLNB during breast conservative surgery, reserving this technique only for mastectomy cases, is increasing. 28 , 31 …”

Section: Discussionmentioning

confidence: 99%

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

Sá¹,

Logullo²,

Elias³

et al. 2021

BCTT

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Background Mammography screening has become widely spread and provided a marked increase in ductal carcinoma in situ (DCIS) diagnosis. In DCIS, the ductal epithelium proliferates without invasion through the basal cell membrane. However, histologic underestimation can happen in some cases. Objective To analyze the rate of histologic underestimation (histopathologic results upgraded to invasive carcinoma after surgery) and the rate of positive results of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS in a Brazilian public hospital. Methods We reviewed medical records of all consecutive patients admitted between 2009 and 2013 whose initial diagnosis was DCIS through core needle biopsy. DCIS cases with a high risk of invasion underwent SLNB. We excluded cases with invasion or micro-invasion components in the first biopsy. Results A total of 86 women were included, most with microcalcifications as the primary radiological lesion (73.2%), and underwent preoperative biopsy, with an invasive component in 21 (24.4%) in the final pathology report. Most had invasive carcinoma of no special type (NST): 52.3% (n = 11) and microinvasive tumors (7 cases, 33.3%). The main factors associated with histologic underestimation were nodular lesion (61.9%, p<0.001) and an ultra-sonography-guided biopsy (71.4%, p=0.0005). The positivity rate of SLNB was 4.3%. All these patients underwent mastectomy, and the initial histologic pattern was solid DCIS. Conclusion The “histologic underestimation” rate among patients with DCIS was not low, and less than 5% of patients who underwent SLNB had axillary positivity. This result suggests that patients who have DCIS and a high risk of invasion and undergoing mastectomy should have SLNB. As to the patients who will undergo lumpectomy, SLNB could be omitted and could be performed if patients have upgraded to invasive breast cancer.

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

Cited by 19 publications

References 27 publications

When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center

When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center

Revisit the Practice of Lymph Node Biopsy in Patients Diagnosed as Ductal Carcinoma In Situ Before Operation: A Retrospective Analysis of 682 Cases and Evaluate the Role of Breast MRI

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

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