Evaluating the role of sentinel lymph node biopsy in patients with DCIS treated with breast conserving surgery

James, Ted A.; Palis, Bryan E.; McCabe, Ryan; Pardo, Jaime; Alapati, Amulya; Ukandu, Ogechi; Serres, Stephanie K.; Zhang, Jennifer; Mele, Alessandra; Facktor, Matthew A.; Shulman, Lawrence N.

doi:10.1016/j.amjsurg.2020.01.014

Cited by 12 publications

(16 citation statements)

References 28 publications

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“…And before the detrimental influence of axillary lymph node metastasis on the survival of patients can be certainly excluded, it is quite of clinical significance to perform SLN biopsy in highly selective patients with a preoperative diagnosis of DCIS because of low positivity of SLN metastasis. SLN metastasis was found in 10.3% (42/407) of patients with preoperative DCIS in this study, a little higher than that reported over the latest five years (6,8,11,12). This may be attributed to the relatively high total upstaging rate (55.3%, 225/407) of this study.…”

Section: Discussioncontrasting

confidence: 56%

“…Therefore, sentinel lymph node (SLN) biopsy is just recommended for patients with preoperatively diagnosed pure DCIS undergoing mastectomy, in case when invasive disease is found in the surgical specimen, a second SLN procedure becomes mandatory but is no more possible (5). However, in clinical practice, a substantial proportion of patients with a preoperative diagnosis of DCIS still undergo SLN biopsy during breast conserving surgery (6)(7)(8)(9)(10). This discrepancy between guidelines and clinical practice may be largely attributed to the reluctance to return to the operating room when occult invasive disease is identified in the surgical specimen.…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…To date, a recent American contribution on this topic, in which data on 15,422 patients with DCIS undergoing BCS in 2015 were extracted from the National Cancer Data Base, revealed an 18% rate of use of SLNB and a very low, 0.9% rate of metastatic SLN [19] . This low rate of nodal involvement argues against the routine use of SLNB for patients with DCIS undergoing BCS.…”

Section: Ductal Carcinoma In Situmentioning

confidence: 99%

“…In a recent meta-analysis, the importance of the amount of SLNs removed in terms of reducing the FNR rate is specifically highlighted. Examining a total of 1,921 women enrolled in 13 studies with initial metastatic biopsy-ascertained nodes after NAC, the meta-analysis found that the FNR rate progressively decreased from 20% (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) to 12% (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and 4% (0-9) with removal of 1, 2, and 3 or more nodes, respectively [34] . The European Institute of Oncology conducted a retrospective study of 396 cT1-4, cN0/1/2 patients, who became or remained cN0 after neoadjuvant treatment and underwent SNB if at least 1 SLN was found.…”

Section: Neoajuvant Chemotherapymentioning

confidence: 99%

Axillary surgery in breast cancer: An updated historical perspective

Magnoni

Galimberti

Corso

et al. 2020

Seminars in Oncology

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This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing effort s of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymphnode biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.

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The Next Step: Use of a Pre‐Operative Checklist to Prevent Missteps

2022

AORN Journal

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Evaluating the role of sentinel lymph node biopsy in patients with DCIS treated with breast conserving surgery

Cited by 12 publications

References 28 publications

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

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

Axillary surgery in breast cancer: An updated historical perspective

The Next Step: Use of a Pre‐Operative Checklist to Prevent Missteps

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