Extent of Microinvasion in Ductal Carcinoma In Situ is not Associated with Sentinel Lymph Node Metastases

Abstract

Background DCIS with microinvasion (DCISM) is a rare diagnosis with a good prognosis. Although nodal metastases are uncommon, sentinel lymph node biopsy (SLNB) remains standard care. Volume of disease in invasive breast cancer is associated with SLNB positivity and, thus, we hypothesized that in a large cohort of patients with DCISM, multiple foci of microinvasion might be associated with a higher risk of positive SLNB. Methods Records from a prospective institutional database were reviewed to identify patients with DCISM who underwent SLNB between June 1997 and December 2010. Pathology reports were reviewed for number of microinvasive foci and categorized as one focus or ≥2 foci. Demographic, pathologic, treatment, and outcome data were obtained and analyzed. Results Of 414 patients, 235 (57%) had one focus of microinvasion and 179 (43%) had ≥2 foci. SLNB macrometastases were found in 1.4% and micrometastases were found in 6.3%; neither were significantly different between patients with one focus vs ≥2 foci (p=1.0). Patients with positive SLNB or ≥2 foci of microinvasion were more likely to receive chemotherapy. At median 4.9 years (range 0-16.2) follow-up, 18 patients, all in the SLNB negative group, had recurred for an overall 5-year recurrence-free proportion of 95.9%. Conclusions Even with large numbers, there was no higher risk of nodal involvement with ≥2 foci of microinvasion as compared to 1 focus. Number of microinvasive foci and results of SLNB appear to be used in decision making for systemic therapy. Prognosis is excellent.

The clinical features and management of women with ductal carcinoma in situ with microinvasion: A retrospective Cohort study

“…Therefore, patients in our hospital underwent chemotherapy after diagnosing as DCISM by final paraffin pathological diagnosis. In concordance with the findings of studies, the prognosis of DCISM was close to that of DCIS in our report, though DCISM is thought to have the intermediate prognosis between pure DCIS and invasive breast cancer [19,20]. Whether it is necessary for patients with DCISM to receive chemotherapy or hormonal therapy should be addressed, because no survival difference between DCIS and DCISM was found.…”

“…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.…”

Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion. Results of a large single-institution series

“…In this study from MSKCC [24], rates of 1.4 and 6.3 % were found for macro-and micrometastases, respectively, with LVI being the only pathologic factor associated with a positive SLNB. Compared to our study, it did not consider ITCs in the nodal metastasis evaluation and it did not include the associated intraductal component of carcinoma dimensions, histotype and grade, and MIBC (T1mi) Ki-67 as pathological factors in the risk factors analysis.…”

Carcinoma microinvasor de mama: resultados em longo prazo

“…Cirurgia conservadora da mama (CCM) tem menor morbidade, mas tem um maior risco de recorrência local. Radioterapia (RT) após CCM reduz o risco de recidiva 9,10 . O tratamento ideal cirúrgico para CMM é indefinido, por falta de ensaios clínicos.…”

“…Com a raridade aparente do CMM e a variedade de definições estabelecidas até então para esta patologia, há pouca e discordante informação na literatura sobre o comportamento biológico desta neoplasia. Desta forma, o manejo cirúrgico, particularmente o manejo da axila e dados de sobrevida livre de doença e global, tem sido controverso 9 . Por definição, CDIS puro não gera metástases, mas a presença de microinvasão possibilita este acontecimento.…”