Revisit the practice of lymph node biopsy in patients diagnosed as ductal carcinoma in situ before operation: a retrospective analysis of 682 cases and evaluation of the role of breast MRI

Abstract

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 was 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 and 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 who 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 < 3 cm, 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 safely 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.

Is it feasible to selectively perform axillary lymph node surgery for patients with biopsy diagnosed Ductal Carcinoma in Situ? A study based on developed and validation of nomogram

“…In the study by Chang [9], the tumor mass according to ultrasound, axillary results on ultrasound, multifocal tumor, surgery, upgrading, and Ki-67 level showed signi cant correlation with SLN metastasis. In multivariate analysis, Lai et al [29] found that metastases were associated with large tumor size in imaging before surgery and invasiveness after surgery. In a database analysis [30], a positive lymph node was associated with younger age, increased size, palpability and surgical excisional biopsy.…”

Effects of the number of removed lymph nodes on survival outcome in patients with sentinel node-negative breast cancer

“…SLNB remains to this day the standard technique for staging the axillary cavity in patients with early-stage breast cancer [20][21][22][23]. It should be noted, despite a good lymph node collection, patients are still exposed to the risk of local or distant recurrence.…”

Could breast multiparametric MRI discriminate between pure ductal carcinoma in situ and microinvasive carcinoma?

“…The presence of possible axillary lymphadenopathies was assessed on T1W sequences. Lymph nodes >1 cm in size, round shape, loss of fatty hilum, and cortical thickening (>3 mm) were considered pathological (21).…”