Sentinel lymph node biopsy can be omitted in DCIS patients treated with breast conserving therapy

Abstract

Breast cancer guidelines advise sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) on core biopsy at high risk of invasive cancer or in case of mastectomy. This study investigates the incidence of SLNB and SLN metastases and the relevance of indications in guidelines and literature to perform SLNB in order to validate whether SLNB is justified in patients with DCIS on core biopsy in current era. Clinically node negative patients diagnosed from 2004 to 2013 with only DCIS on core needle biopsy were selected from a national database. Incidence of SLN biopsy and metastases was calculated. With Fisher exact tests correlation between SLNB indications and actual presence of SLN metastases was studied. Further, underestimation rate for invasive cancer and correlation with SLN metastases was analysed. 910 patients were included. SLNB was performed in 471 patients (51.8 %): 94.5 % had pN0, 3.0 % pN1mi and 2.5 % pN1. Patients undergoing mastectomy had 7 % SLN metastases versus 3.5 % for breast conserving surgery (BCS) (p = 0.107). The only factors correlating to SLN metastases were smaller core needle size (p = 0.01) and invasive cancer (p < 0.001). Invasive cancer was detected in 16.7 % by histopathology with 15.6 % SLN metastases versus only 2 % in pure DCIS. SLNB showed metastases in 5.5 % of patients; 3.5 % in case of BCS (any histopathology) and 2 % when pure DCIS was found at definitive histopathology (BCS and mastectomy). Consequently, SLNB should no longer be performed in patients diagnosed with DCIS on core biopsy undergoing BCS. If definitive histopathology shows invasive cancer, SLNB can still be considered after initial surgery.

Trends and clinicopathological predictors of axillary evaluation in ductal carcinoma in situ patients treated with breast‐conserving therapy

“…Open biopsy and Mammotome biopsy could potentially provide adequate tissue for pathology examination and decrease the chance of upstaging to invasive disease in the second surgery; therefore, they were associated with a lower incidence of axially evaluation. By contrast, DCIS diagnosed by core needle biopsy had an approximately 20% chance of being upstaged to invasive cancer due to the inadequate sampling [5,18]. Even in core needle biopsy-diagnosed DCIS, a smaller core needle size was also positively correlated with an increased rate of upstaging and SLN metastases [5].…”

“…By contrast, DCIS diagnosed by core needle biopsy had an approximately 20% chance of being upstaged to invasive cancer due to the inadequate sampling [5,18]. Even in core needle biopsy-diagnosed DCIS, a smaller core needle size was also positively correlated with an increased rate of upstaging and SLN metastases [5]. Future studies should investigate the optimal biopsy method for clinically suspicious DCIS and decrease unnecessary axillary evaluation due to inadequate sampling.…”

“…Van Roozendaal et al. reported a 38.8% SLNB rate among core needle‐biopsied DCIS patients treated with BCT in the Netherlands in 2004–2013, while none of the patients underwent ALND . Worni et al.…”

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

“…In 16 patients (5.9%) sentinel lymph node biopsy was not performed, because these patients were affected by pure ductal carcinoma in situ undergoing breast‐conserving surgery, therefore axillary staging was not routinely recommended . However, the other 13 patients affected by intraductal cancer received sentinel node biopsy, due to associated high‐risk features predictive of upstaging to the invasive disease on postoperative histopathology …”

Pathological Examination of Sentinel Lymph Node Biopsy

“…DKİS olgularında, invaziv odak olma olasılığı nedeniyle SLDB'si yapılması ilgi görmüş (21), tru-cut (cor) biyopside, invaziv kanser riski yüksek olanlar ya da mastektomi düşünülen olgulara SLDB'si önerilmiştir (22,23). Erkeklerde meme kanseri çok az görülmekte ve meme kanserlerinin yaklaşık %1'ini oluşturmaktadır.…”