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Sentinel Node Biopsy in Ductal Carcinoma In Situ Patients

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Abstract

Background: Sentinel lymph node (SLN) mapping is an effective and accurate method of evaluating the regional lymph nodes in breast cancer patients. The SLN is the first node that receives lymphatic drainage from the primary tumor. Patients with micrometastatic disease, previously undetected by routine hematoxylin and eosin (H&E) stains, are now being detected with the new technology of SLN biopsy, followed by a more detailed examination of the SLN that includes serial sectioning and cytokeratin immunohistochemical (CK IHC) staining of the nodes.

Methods: At Moffitt Cancer Center, 87 patients with newly diagnosed pure ductal carcinoma in situ (DCIS) lesions were evaluated by using CK IHC staining of the SLN. Patients with any focus of microinvasive disease, detected on diagnostic breast biopsy by routine H&E, were excluded from this study. DCIS patients, with biopsy-proven in situ tumor by routine H&E stains, underwent intraoperative lymphatic mapping, using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised SLNs were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. All SLNs that had only CK-positive cells were subsequently confirmed malignant by a more detailed histological examination of the nodes.

Results: CK IHC staining was performed on 177 SLNs in 87 DCIS breast cancer patients. Five of the 87 DCIS patients (6%) had positive SLNs. Three of these patients were only CK positive and two were both H&E and CK positive. Therefore, routine H&E staining missed microinvasive disease in three of five DCIS patients with positive SLNs. In addition, DCIS patients with occult micrometastatic disease to the SLN underwent a complete axillary lymph node dissection, and the SLNs were the only nodes found to have metastatic disease. Of interest, four of the five nodepositive patients had comedo carcinoma associated with the DCIS lesion, and one patient had a large 9.5-cm low grade cribriform and micropapillary type of DCIS.

Conclusions: This study confirms that lymphatic mapping in breast cancer patients with DCIS lesions is a technically feasible and a highly accurate method of staging patients with undetected micrometastatic disease to the regional lymphatic basin. This procedure can be performed with minimal morbidity, because only one or two SLNs, which are at highest risk for containing metastatic disease, are removed. This allows the pathologist to examine the one or two lymph nodes with greater detail by using serial sectioning and CK IHC staining of the SLNs. Because most patients with DCIS lesions detected by routine H&E stains do not have regional lymph node metastases, these patients can safely avoid the complications associated with a complete axillary lymph node dissection and systemic chemotherapy. However, DCIS patients with occult micrometastases of the regional lymphatic basin can be staged with higher accuracy and treated in a more selective fashion.

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REFERENCES

  1. Frykberg ER, Bland KI. In situ breast carcinoma. Adv Surg 1993;26:29–72.

    Google Scholar 

  2. Archer S, Winchester DS. Noninvasive breast cancer. In: Berger DH, Feig BW, Fuhrman GM eds. The M. D. Anderson Surgical Oncology Handbook. 1995:1–11.

  3. Cox CE, Pendas S, Cox JE, et al. Guidelines for sentinel node biopsy and lymphatic mapping of breast cancer patients. Ann Surg 1998;227:645–53.

    Article  CAS  PubMed  Google Scholar 

  4. Cox CE, Bass SS, Ku NN, et al. Sentinel lymphadenectomy. a safe answer to less axillary surgery. In: Proceedings of the 6th International Conference on Adjuvant Therapy of Primary Breast Cancer, St Gallen, Switzerland, February 25–28, 1998.

  5. Turner RR, Ollila DW, Krasne DL, Giuliano AE. Histopathological validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 1997;226:271–276.

    Article  CAS  PubMed  Google Scholar 

  6. Albertini JJ, Lyman GH, Cox CE, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996;276:1818–1822.

    Article  CAS  PubMed  Google Scholar 

  7. Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995;222:394–399.

    Google Scholar 

  8. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. Lancet 1997;349:1864–1867.

    Article  CAS  PubMed  Google Scholar 

  9. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping, and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391–398.

    PubMed  Google Scholar 

  10. Giuliano AE. Lymphatic mapping, and sentinel node biopsy in breast cancer (letter). JAMA 1997;277:791–792.

    Google Scholar 

  11. Giuliano AE, Jones RC, Brennan M, Statman RR. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345–2350.

    Google Scholar 

  12. Dowlatshahi K, Fan M, Snider HC. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer 997;80:1188–1197.

    Google Scholar 

  13. Anderson BO, Austin-Seymour M, Gralow J, Moe RR, Byrd DR. A multidisciplinary approach to locoregional management of the axilla for primary operable breast cancer. Cancer Control J Moffitt Cancer Center 1997;4:491–504.

    Google Scholar 

  14. Copeland EM III. Is axillary dissection necessary for T1 carcinoma of the breast. J Am Coll Surg 1997;184:397–398.

    Google Scholar 

  15. Ruffin WK, Stacey-Clear A, Younger J, Hoover HC. Rational for routine axillary dissection in carcinoma of the breast. J Am Coll Surg 1995;180:245–251.

    Google Scholar 

  16. Graversen HP, Blichert-Toft M, Andersen JA, Zedeler K. Breast cancer: risk of axillary recurrence in node negative patients following partial dissection of the axilla. Eur J Surg Oncol 1988;14:407–412.

    Google Scholar 

  17. Cady B. Is axillary lymph node dissection necessary in routine management of breast cancer? No. Important Adv Oncol 1996;251–265.

  18. Haffty BG, Ward B, Pathare P. Reappraisal of the role of axillary lymph node dissection in conservative treatment of breast cancer. J Clin Oncol 1997;15:691–700.

    Google Scholar 

  19. Noguchi M. Node negative breast cancer patients exposed to unnecessary perioperative risk and increased long-term morbidity (letter). Ann Surg 1997;225:126–136.

    Google Scholar 

  20. Redding WH, Coombes RC. Detection of micrometastases in patients with primary breast cancer. Lancet 1983;2:1271–1274.

    Google Scholar 

  21. International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet 1990;335:1565–1568.

    Google Scholar 

  22. Shoenfeld A, Lugamani Y, Smith D, et al. Detection of breast cancer micro- metastases in axillary lymph nodes by using polymerase chain reaction. Cancer Res 1994;54:2986–2990.

    Google Scholar 

  23. Noguchi S, Aihara T, Motomura K, et al. Detection of breast cancer micro- metastases in axillary lymph nodes by means of reverse transcriptase-polymerase chain reaction. Am J Pathol 1996;2:649–656.

    Google Scholar 

  24. Noguchi S, Aihara T, Motomura K, et al. Histologic characteristics of breast cancers with occult lymph node metastases detected by keratin 19 mRNA reverse transcriptase-polymerase chain reaction. Cancer 1996;78:1235–1240.

    Google Scholar 

  25. Ku NK, Ahmad N, Smith PV, Cox CE, Reintgen DS, Nicosia SV. Intraoperative imprint cytology of sentinel lymph nodes in breast cancer. Acta Cytol 1997;41:1606–1607.

    Google Scholar 

  26. Cox CE, Ku NN, Reintgen DS, et al. Touch preparation cytology of breast lumpectomy margins with histologic correlation. Arch Surg 1991;126:490–493.

    Google Scholar 

  27. Iglehart JD. The breast. In: Sabiston DC Jr, ed. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Philadelphia: WB Saunders, 15th ed. 1997:569–71.

    Google Scholar 

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Authors and Affiliations

  1. Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida

    Solange Pendas MD, Emilia Dauway MD, Rosemary Giuliano MD, NiNi Ku MD, Charles E. Cox MD & Douglas S. Reintgen MD

  2. H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612-9497

    Douglas S. Reintgen MD

Authors
  1. Solange Pendas MD
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  2. Emilia Dauway MD
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  3. Rosemary Giuliano MD
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  4. NiNi Ku MD
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  5. Charles E. Cox MD
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  6. Douglas S. Reintgen MD
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Correspondence to Douglas S. Reintgen MD.

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Pendas, S., Dauway, E., Giuliano, R. et al. Sentinel Node Biopsy in Ductal Carcinoma In Situ Patients. Ann Surg Oncol 7, 15–20 (2000). https://doi.org/10.1007/s10434-000-0015-z

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  • DOI: https://doi.org/10.1007/s10434-000-0015-z

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