The Utility of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Suspicious for Microinvasion on Core Biopsy

Namm, Jukes P.; Mueller, Jeffrey; Kocherginsky, Masha; Kulkarni, Swati

doi:10.1245/s10434-014-3943-8

Cited by 14 publications

(5 citation statements)

References 34 publications

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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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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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“…Besides, when small cancer nests or single cells seem to be focally extending out from DCIS, it is challenging to tell whether these cells are truly invasive or not. 9 These cases are diagnosed as DCIS with suspicious microinvasion. In this study, we found that DCIS with suspicious microinvasion was the single most significant pathological feature that correlated with upgrading risk.…”

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confidence: 99%

Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients

et al. 2021

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Stratifying ductal carcinoma in situ (DCIS) patients into different upgrading risk groups is important in exploiting more precise therapeutic options. Evaluation of estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status and axillary lymph node metastatic status for DCIS and their upgraded invasive counterparts can also provide diagnostic and therapeutic implications. We retrospectively studied 575 patients with first-time diagnosis of DCIS on biopsies, and followed up their final diagnosis, ER/PR/HER2 status, and axillary lymph node involvement on excisions. As a result, biopsy-diagnosed DCIS had an overall 19.1% risk to be upgraded on subsequent excisions, with 4.7% being upgraded to microinvasive carcinoma (pT1mi) and 14.4% to overt invasive carcinoma (⩾pT1a). Factors significantly associated with higher upgrading risk on multivariate analysis include biopsy guidance by ultrasound ( P <.001), DCIS with suspicious microinvasion ( P < .001), and DCIS diagnosed in left breast ( P = .026). DCIS diagnosed in younger patients (⩽40 years old) or DCIS with high nuclear grade showed higher upgrading risk only on univariate analysis. About 80% ER + /PR + and ER−/PR− DCIS remained the same ER/PR status after being upgraded, and ER + /PR − DCIS had the highest risk (63.6%) of having HER2 amplification in upgraded invasive carcinoma. For upgraded DCIS, microinvasive carcinoma was more likely to have HER2 amplification (50%) than overt invasive carcinoma (29.5%). Besides, pure DCIS had a low risk of axillary lymph node macrometastasis (0.74%), while the risk increased in DCIS with microinvasion (4.4%) and was highest in overt invasive carcinoma (14.7%). The findings of this study are clinically relevant with respect to criteria that might be used in selecting patients for de-escalation trials.

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“…Our results are concordant with the only other study that, to our knowledge, addresses this topic. 5…”

Section: Presentmentioning

confidence: 99%

ASO Author Reflections: Sentinel Lymph Node Biopsy for Ductal Carcinoma In Situ with Suspicion for Microinvasion on Core Needle Biopsy

Flanagan

Cody

2019

Ann Surg Oncol

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The Utility of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Suspicious for Microinvasion on Core Biopsy

Abstract: In patients with Smic on CNB, the incidence of macrometastatic nodal disease after SLNB is rare. Surgeons may consider omitting SLNB until IDC is definitively confirmed, especially in patients with Smic apart from other high-risk features.

Cited by 14 publications

References 34 publications

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

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

Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients

ASO Author Reflections: Sentinel Lymph Node Biopsy for Ductal Carcinoma In Situ with Suspicion for Microinvasion on Core Needle Biopsy

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