Axillary Node Staging for Microinvasive Breast Cancer: Is It Justified?

Lyons, John; Stempel, Michelle; Zee, Kimberly J. Van; Cody, Hiram S.

doi:10.1245/s10434-012-2376-5

Cited by 41 publications

(27 citation statements)

References 41 publications

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“…Two of the seven patients (29%) had multifocal microinvasion. All seven cases showed either intermediate (4) or high-grade (3) duct carcinoma in situ, of which three had comedo necrosis.…”

Section: Resultsmentioning

confidence: 98%

“…Some of the larger studies in recent years have also concluded that involvement of sentinel lymph nodes in microinvasive carcinoma is primarily in the form of isolated tumor cells and micrometastases, and additional non-sentinel axillary lymph nodes are positive only when the sentinel lymph node harbors a macrometastases. 4,[35][36][37][38] The study by Ko et al, 37 The clinical and prognostic significance of minimal tumor burden in the axilla of breast cancer patients is uncertain. As the majority of microinvasive carcinoma patients (more than 90%) harbor only isolated tumor cells and micrometastases, one might reasonably conclude that sentinel lymph node biopsy and its rigorous pathologic evaluation is an unnecessary exercise in a case of microinvasive carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Owing to its low incidence, the prognosis of microinvasive carcinoma is not well established, but is believed to be intermediate between duct carcinoma in situ and invasive breast carcinomas. 3,4 The reported incidence of axillary lymph node metastasis in microinvasive carcinoma ranges between 0 and 25%. 4,5 Given the high incidence of axillary lymph node metastasis in some reports, sentinel lymph node biopsy is routinely performed in patients with microinvasive carcinoma.…”

mentioning

confidence: 99%

“…3,4 The reported incidence of axillary lymph node metastasis in microinvasive carcinoma ranges between 0 and 25%. 4,5 Given the high incidence of axillary lymph node metastasis in some reports, sentinel lymph node biopsy is routinely performed in patients with microinvasive carcinoma. In addition, many patients undergo second surgical procedure for sentinel lymph node biopsy when a diagnosis of microinvasive carcinoma is rendered on definitive surgery as an upgrade to duct carcinoma in situ diagnosed on core biopsy.…”

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confidence: 99%

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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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“…Two of the seven patients (29%) had multifocal microinvasion. All seven cases showed either intermediate (4) or high-grade (3) duct carcinoma in situ, of which three had comedo necrosis.…”

Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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: 99%