Sentinel lymph node biopsy is not warranted following a core needle biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast

Prendeville, Susan; Ryan, Ciara; Feeley, Linda; O’Connell, Fionnuala; Browne, Tara Jane; O’Sullivan, M. J.; Bennett, Michael

doi:10.1016/j.breast.2015.01.004

Cited by 31 publications

(26 citation statements)

References 26 publications

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“…24 Routine use of sentinel lymph node dissection (SLND) in DCIS is not recommended except for patients at high-risk for invasive disease, particularly for those undergoing breast-conserving surgery. 25 Nowadays in case of performing a mastectomy due to DCIS, SLN is the standard of care. 24 Nevertheless, our cohort of patients involves a long frame period, during which avoiding FAD and SLND was not the standard of care.…”

Section: Resultsmentioning

confidence: 99%

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Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study

et al. 2017

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The objective was to determine the 10-year oncological safety of nipple-sparing mastectomy (NSM) in patients diagnosed with ductal carcinoma in situ (DCIS). The use of NSM preserves the nipple-areola complex (NAC). As residual fibroglandular breast tissue can remain behind the spared NAC, its use for patient with breast cancer is controversial. The oncologic outcomes and complication rates after performing NSM compared to other techniques are still under debate and a concern when treating patients with breast cancer. We retrospectively reviewed 69 consecutive NSM patients diagnosed with DCIS during 1984-2016 at the Valencia Institute of Oncology, Valencia, Spain. 13 of 82 reviewed cases were excluded from the analysis owing to the presence of invasive tumor in the final pathologic report. All 69 patients who underwent NSM due to DCIS were included and analyzed. The indications were as follows: unfavorable correlation between tumor size and breast size in 53 patients, 10 patients with multifocal or multicentric tumors and breast cancer recurrence after breast-conserving surgery in six patients. The reconstruction was performed using a prosthetic implant: saline-filled implant 33 (47.8%) or tissue expander 36 (52.2%). No frozen section was performed in the patients included in our study. The presence of DCIS was confirmed in 60 patients and in the other nine patients we found no tumor in the mastectomy specimen (removed due to excisional biopsy procedure). High risk features were: tumor grade 3 in 27 (39.2%) cases and comedonecrosis in 32 (46.4%) cases. In 27 patients surgical axillary staging was performed and no residual disease in the axilla was observed. After a mean follow-up period of 142.6 ± 70.7 months no nipple necrosis was observed. In 15 patients (21.7%) an additional surgical procedure was performed. 48 patients (69.6%) did not receive any adjuvant treatment. Adjuvant hormone therapy was given to 20 patients (29%) and one patients received radiation therapy (1.4%). Eight patients showed a local relapse (11.6%). One patient developed a recurrence within the nipple-areola region presented as Paget's disease (1.4%). One patient presented a thorax wall relapse after 42 months of disease-free survival and died because of metastatic dissemination of the tumor. The DFS rate was 88.4% and the overall survival rate was 98.6%. In patients with DCIS that are not candidates to breast-conserving therapy, NSM is a realistic option of treatment. No case of nipple necrosis was observed. A low rate of nipple relapse (1.4%) and a good survival rate (98.5%) were observed after a median follow-up of 142.6 months.

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Section: Resultsmentioning

confidence: 99%

“…Routine use of sentinel lymph node dissection (SLND) in DCIS is not recommended except for patients at high‐risk for invasive disease, particularly for those undergoing breast‐conserving surgery . Nowadays in case of performing a mastectomy due to DCIS, SLN is the standard of care …”

Section: Discussionmentioning

confidence: 99%

Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study

et al. 2017

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“…Sentinel lymph node biopsy is not the standard of care in DCIS of the breast . Indeed, various studies demonstrated a widely variable proportion of DCIS patients with SLNB positive for metastatic disease, ranging from 1% to 22% . Therefore, the role of SLNB procedure in such patients remains controversial, but anyway there is a very small subset of DCIS patients whose clinical management could be changed by SLNB.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Indeed, various studies demonstrated a widely variable proportion of DCIS patients with SLNB positive for metastatic disease, ranging from 1% to 22%. [13][14][15][16][17] Therefore, the role of SLNB procedure in such patients remains controversial, but anyway there is a very small subset of DCIS patients whose clinical management could SORRENTINO ET AL. 12,21,22 However, the presence of multiple macrometastases in axillary nodes still requires axillary dissection and points out the need for adjuvant chemotherapy and tighter follow-up.…”

Section: Discussionmentioning

confidence: 99%

Sentinel node biopsy in ductal carcinoma in situ of the breast: Never justified?

et al. 2017

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Sentinel lymph node biopsy for ductal carcinoma in situ (DCIS) of the breast is not standard of care. However, nodal involvement for DCIS patients is reported. Aim of our study was to identify preoperative features predictive of nodal involvement in DCIS patients. We have retrospectively reviewed 175 patients with a preoperative diagnosis of DCIS following a vacuum-assisted breast biopsy, and undergoing surgery with sentinel node biopsy. Variables distribution was compared between patients upstaged to invasive cancer at final pathology and patients with a confirmed DCIS, and between positive vs negative sentinel node patients. Univariate and multivariate analyses were performed for risk of a positive node. Lymph node biopsy was positive in 13 (7.4%) patients, with 8 (61.5%) macrometastases and 5 (38.5%) micrometastases. In these patients, Breast Imaging Reporting and Data System (BI-RADS) index >4 (OR 4.69, 95% CI 1.282-17.224, P = .02), lesion extension ≥20 mm (OR 4.25, 95% CI 1.255-14.447, P = .02), multifocal disease (OR 4.12, 95% CI 0.987-17.174, P = .05), comedo type (OR 3.54, 95% CI 1.044-11.969, P = .04), and upstaging (OR 4.56, 95% CI 1.080-19.249, P = .04) were all predictive of nodal involvement, although upstaging could not be predicted preoperatively. By multivariate analysis, the only independent factor predictive for positive sentinel node was multifocal disease (OR 5.14, 95% CI 1.015-26.066, P < .05). A preoperative diagnosis of DCIS, also including advanced biopsy systems such as vacuum-assisted breast biopsy, may be not always sufficient to exclude patients from sentinel node biopsy. DCIS patients with associated BI-RADS >4, lesion extension ≥20 mm, comedo type, and above all multifocal disease should be considered for axillary evaluation.

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“…4,10,12,13 Reported rates for performance of SLNB for DCIS range from 21 to 97 %, but these rates are reported primarily from single-institution studies examining predictors of SLNB positivity, which select for tumors with high-risk characteristics. 6,[14][15][16] In 2010, the rate was 17.8 % for lumpectomy patients and 67.1 % for mastectomy patients in the Surveillance, Epidemiology, and End Results (SEER) database, although this was based on the number of lymph nodes examined rather than the specific type of axillary surgery. 17 In 2012, the National Cancer Data Base (NCDB) began collecting information on whether SLNB or axillary lymph node dissection (ALND) was performed in addition to the number of nodes removed.…”

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confidence: 99%

Utilization of Axillary Surgery for Patients With Ductal Carcinoma In Situ: A Report From the National Cancer Data Base

et al. 2016

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Sentinel lymph node biopsy is not warranted following a core needle biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast

Cited by 31 publications

References 26 publications

Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study

Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study

Sentinel node biopsy in ductal carcinoma in situ of the breast: Never justified?

Utilization of Axillary Surgery for Patients With Ductal Carcinoma In Situ: A Report From the National Cancer Data Base

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