The Influence of Hospital and Surgeon Factors on the Prevalence of Axillary Lymph Node Evaluation in Ductal Carcinoma In Situ

Coromilas, Ellie J.; Wright, Jason D.; Huang, Yongmei; Feldman, Sheldon; Neugut, Alfred I.; Chen, Ling; Hershman, Dawn L.

doi:10.1001/jamaoncol.2015.0389

Cited by 28 publications

(30 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Morbidity is not neglectable and cost and resources have to be considered as well. Coromilas et al found an increasing use of SNB in the US in women treated with a mastectomy and they concluded that an additional prospective evaluation is needed to determine if there is a clinical benefit of SNB in women with DCIS [24].…”

Section: Discussionmentioning

confidence: 99%

A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years

et al. 2016

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years

et al. 2016

View full text Add to dashboard Cite

“…13,14 The primary indication of SLNB at the time of mastectomy for in-situ disease is to provide axillary staging in the event that invasive carcinoma is detected on final pathology. Although there are limited data showing the feasibility of SLNB following mastectomy, the identification rates are significantly lower 15 and ALND remains the standard of care for axillary staging in patients with a preoperative diagnosis of DCIS found to have concomitant invasive disease after mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Is Sentinel Lymph Node Biopsy Indicated at Completion Mastectomy for Ductal Carcinoma In Situ?

et al. 2016

View full text Add to dashboard Cite

Background Sentinel lymph node biopsy (SLNB) is recommended when mastectomy is performed for ductal carcinoma in situ (DCIS). The role of SLNB for women with DCIS who undergo mastectomy following ≥1 attempts at breast-conserving surgery (BCS) is uncertain. We examined the upgrade rate and SLNB yield in women who converted to mastectomy after ≥1 attempts at BCS for DCIS. Methods All patients who underwent ≥1 attempts at BCS prior to conversion to mastectomy with SLNB for DCIS were identified. Margin status as the indication for mastectomy was confirmed. Comparisons were made between patients with/without upgrade on final pathology. Results From 2/2006–11/2012, 233 patients underwent completion mastectomy following ≥1 attempts at BCS for positive/close margins (median age,50 years; range 34–84). Median number of BCS attempts was 1 (range 1–4). Overall, 20 (9%) patients were upgraded on final pathology; 15 (6%)stage I, 5(3%) stage II (3 micrometastasis,2 macrometastasis). In 2 of 5 cases with a positive SLN, invasive carcinoma was not identified in the mastectomy specimen. The only factor associated with any upgrade was the presence of micropapillary DCIS (80% versus 55%, with and without upgrade; p = 0.03). Conclusion In this cohort of patients with DCIS who converted to mastectomy for positive/close margins after ≥1 attempts at BCS, 18 (8%) would have required second-stage axillary surgery had a SLNB not been performed and in 2 (1%) patients the SLN provided the only evidence of invasion. These findings support the recommendation for SLNB at the time of completion mastectomy.

show abstract

“…However, a substantial proportion of breast surgeons still perform SLNB in these cases, with an increasing trend over time . This discrepancy between guidelines and current clinical practice may reflect some uncertainty and a need for further research in this field, and some important clinical issues have been emerged . Indeed, if upstaging to invasive ductal carcinoma is found on final pathology, the patient would need a second surgical procedure to perform SLNB.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

The Influence of Hospital and Surgeon Factors on the Prevalence of Axillary Lymph Node Evaluation in Ductal Carcinoma In Situ

Cited by 28 publications

References 50 publications

A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years

A validation of DCIS registration in a population-based breast cancer quality register and a study of treatment and prognosis for DCIS during 20 years

Is Sentinel Lymph Node Biopsy Indicated at Completion Mastectomy for Ductal Carcinoma In Situ?

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

Contact Info

Product

Resources

About