Skip to main content

Advertisement

SpringerLink
Log in

Sentinel Lymph Node Biopsy: Is It Indicated in Patients With High-Risk Ductal Carcinoma-In-Situ and Ductal Carcinoma-In-Situ With Microinvasion?

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Axillary lymph node status is the strongest prognostic indicator of survival for women with breast cancer. The purpose of this study was to determine the incidence of sentinel node metastases in patients with high-risk ductal carcinoma-in-situ (DCIS) and DCIS with microinvasion (DCISM).

Methods: From November 1997 to November 1999, all patients who underwent sentinel node biopsy for high-risk DCIS (n = 76) or DCISM (n = 31) were enrolled prospectively in our database. Patients with DCIS were considered high risk and were selected for sentinel lymph node biopsy if there was concern that an invasive component would be identified in the specimen obtained during the definitive surgery. Patients underwent intraoperative mapping that used both blue dye and radionuclide. Excised sentinel nodes were serially sectioned and were examined by hematoxylin and eosin and by immunohistochemistry.

Results: Of 76 patients with high-risk DCIS, 9 (12%) had positive sentinel nodes; 7 of 9 patients were positive for micrometastases only. Of 31 patients with DCISM, 3 (10%) had positive sentinel nodes; 2 of 3 were positive for micrometastases only. Six of nine patients with DCIS and three of three with DCISM and positive sentinel nodes had completion axillary dissection; one patient with DCIS had an additional positive node detected by conventional histological analysis.

Conclusions: This study documents a high incidence of lymph node micrometastases as detected by sentinel node biopsy in patients with high-risk DCIS and DCISM. Although the biological significance of breast cancer micrometastases remains unclear at this time, these findings suggest that sentinel node biopsy should be considered in patients with high-risk DCIS and DCISM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000;50:7–33.

    CAS  PubMed  Google Scholar 

  2. Silverstein MJ, Gierson ED, Waisman JR, Senofsky GM, Colburn WJ, Gamagami P. Axillary lymph node dissection for T1a breast carcinoma. Is it indicated? Cancer 1994;73:664–667.

    Google Scholar 

  3. Yiangou C, Shousha S, Sinnett HD. Primary tumour characteristics and axillary lymph node status in breast cancer. Br J Cancer 1999;80:1974–1978.

    Google Scholar 

  4. Solin LJ, Kurtz J, Fourquet A, et al. Fifteen-year results of breastconserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol 1996;14:754–763.

    Google Scholar 

  5. Wong JH, Kopald KH, Morton DL. The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer. Arch Surg 1990;125:1298–1301.

    Google Scholar 

  6. Silverstein MJ, Gierson ED, Colburn WJ, Rosser RJ, Waisman JR, Gamagami P. Axillary lymphadenectomy for intraductal carcinoma of the breast. Surg Gynecol Obstet 1991;172:211–214.

    Google Scholar 

  7. Solin LJ, Fowble BL, Yeh IT, et al. Microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation. Int J Radiat Oncol Biol Phys 1992;23:961–968.

    Google Scholar 

  8. Silver SA, Tavassoli FA. Mammary ductal carcinoma in situ with microinvasion. Cancer 1998;82:2382–2390.

    Google Scholar 

  9. Le Bouedec G, Penault-Llorca F, de Latour M, et al. Carcinome canalaire micro-invasif du sein. Place du curage ganglionnaire axillaire [Microinvasive ductal carcinoma of the breast. Role of axillary lymph node dissection]. J Gynecol Obstet Biol Reprod (Paris) 1999;28:10–16.

    Google Scholar 

  10. Nasser IA, Lee AK, Bosari S, Saganich R, Heatley G, Silverman ML. Occult axillary lymph node metastases in “node-negative” breast carcinoma. Hum Pathol 1993;24:950–957.

    Article  CAS  PubMed  Google Scholar 

  11. Hainsworth PJ, Tjandra JJ, Stillwell RG, et al. Detection and significance of occult metastases in node-negative breast cancer. Br J Surg 1993;80:459–463.

    CAS  PubMed  Google Scholar 

  12. McGuckin MA, Cummings MC, Walsh MD, Hohn BG, Bennett IC, Wright RG. Occult axillary node metastases in breast cancer: their detection and prognostic significance. Br J Cancer 1996;73:88–95.

    Google Scholar 

  13. Cote RJ, Peterson HF, Chaiwun B, et al. Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group. Lancet 1999;354:896–900.

    Article  CAS  PubMed  Google Scholar 

  14. Dowlatshahi K, Fan M, Bloom KJ, Spitz DJ, Patel S, Snider HC Jr. Occult metastases in the sentinel lymph nodes of patients with early stage breast carcinoma: A preliminary study. Cancer 1999;86:990–996.

    Google Scholar 

  15. Cox CE, Bass SS, Ku NN, et al. Sentinel lymphadenectomy: a safe answer to less axillary surgery? Recent Results Cancer Res 1998;152:170–179.

    Google Scholar 

  16. Hill AD, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528–535.

    Google Scholar 

  17. Silverstein MJ, Poller DN, Waisman JR, et al. Prognostic classification of breast ductal carcinoma-in-situ. Lancet 1995;345:1154–1157.

    Article  Google Scholar 

  18. Dowlatshahi K, Fan M, Snider HC, Habib FA. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer 1997;80:1188–1197.

    Google Scholar 

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

    Google Scholar 

  20. Diel IJ, Kaufmann M, Costa SD, et al. Micrometastatic breast cancer cells in bone marrow at primary surgery: prognostic value in comparison with nodal status. J Natl Cancer Inst 1996;88:1652–1658.

    Google Scholar 

  21. Braun S, Pantel K, Muller P, et al. Cytokeratin-positive cells in the bone marrow and survival of patients with stage I, II, or III breast cancer. N Engl J Med 2000;342:525–533.

    Article  CAS  PubMed  Google Scholar 

  22. Stomper PC, Margolin FR. Ductal carcinoma in situ: the mammographer’s perspective. AJR Am J Roentgenol 1994;162:585–591.

    Google Scholar 

  23. Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol 1998;171:35–40.

    Google Scholar 

  24. Pendas S, Dauway E, Giuliano R, Ku N, Cox CE, Reintgen DS. Sentinel node biopsy in ductal carcinoma in situ patients. Ann Surg Oncol 2000;7:15–20.

    Google Scholar 

  25. Zavotsky J, Hansen N, Brennan MB, Turner RR, Giuliano AE. Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer 1999;85:2439–2443.

    Google Scholar 

  26. Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441–452.

    Google Scholar 

  27. Silverstein MJ, Lagios MD, Martino S, et al. Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast. J Clin Oncol 1998;16:1367–1373.

    Google Scholar 

  28. Solin LJ, Kurtz J, Fourquet A, et al. Fifteen-year results of breastconserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol 1996;14:754–763.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

    Nancy Klauber-DeMore MD, Jane Fey MPH, Patrick Borgen MD, Alexandra Heerdt MD, MPH, Leslie Montgomery MD, Michael Paglia MD, Jeanne A. Petrek MD, Hiram S. Cody III MD & Kimberly J. Van Zee MD

  2. Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Lee K. Tan MD & Stamatina Kaptain MD

  3. Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Laura Liberman MD

  4. Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI 1026, New York, NY, 10021

    Kimberly J. Van Zee MD

Authors
  1. Nancy Klauber-DeMore MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lee K. Tan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Liberman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stamatina Kaptain MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane Fey MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Borgen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexandra Heerdt MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Leslie Montgomery MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael Paglia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeanne A. Petrek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiram S. Cody III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kimberly J. Van Zee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klauber-DeMore, N., Tan, L.K., Liberman, L. et al. Sentinel Lymph Node Biopsy: Is It Indicated in Patients With High-Risk Ductal Carcinoma-In-Situ and Ductal Carcinoma-In-Situ With Microinvasion?. Ann Surg Oncol 7, 636–642 (2000). https://doi.org/10.1007/s10434-000-0636-2

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-000-0636-2

Key Words

Search

Navigation