Axillary Node Staging for Microinvasive Breast Cancer: Is It Justified?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The natural history and role of axillary staging in microinvasive breast cancer (DCISM) remains controversial. We report clinical characteristics and outcome in patients with DCISM, focusing on the role of sentinel lymph node (SLN) biopsy.
From our prospective database we retrospectively identified 112 patients with DCISM who underwent SLN biopsy between 1996 and 2004 at our institution. Median follow-up was 6 years.
We found positive SLN in 12 % of patients (14 of 112): macrometastasis in 2.7 % (3 of 112) and micrometastases or isolated tumor cells (ITC) in 10 % (11 of 112). We performed axillary dissection (ALND) in all patients with macrometastasis (3 of 3), finding additional positive nodes in 66 % (2 of 3), and in 27 % of those with micrometastases/ITCs (3 of 11), finding no additional positive nodes. Among 98 patients with negative SLN (38 % of whom received systemic therapy), there were 5 locoregional recurrences (1 in the ipsilateral axilla, 4 in the ipsilateral breast, all DCIS) and 4 contralateral second primary cancers. Among 14 patients with positive SLN (82 % of whom received systemic adjuvant therapy), there were no locoregional or distant recurrences.
Our results suggest that SLN biopsy may be justified for DCISM, but is clearly most beneficial to identify a very small subset of DCISM patients (2.7 %, with SLN macrometastasis) who could benefit from systemic adjuvant therapy. The benefit of SLN biopsy for patients with SLN micrometastases/ITCs (pN0mi or pN0(i+)) is uncertain, and in these cases ALND does not appear to be warranted. We suggest a wider reappraisal of routine SLN biopsy for DCISM.
- Yang M, Moriya T, Oguma M, De La Cruz C, Endoh M, Ishida T, et al. Microinvasive ductal carcinoma (T1mic) of the breast. The clinicopathological profile and immunohistochemical features of 28 cases. Pathol Int. 2003;53:422–8. CrossRef
- Harris JR. Diseases of the Breast. Philadelphia: Lippincott Williams & Wilkins, 2010.
- Camp R, Feezor R, Kasraeian A, Cendan J, Schell S, Wilkinson E, et al. Sentinel lymph node biopsy for ductal carcinoma in situ: an evolving approach at the University of Florida. Breast J. 2005;11:394–7. CrossRef
- Gray RJ, Mulheron B, Pockaj BA, Degnim A, Smith SL. The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era. Am J Surg. 2007;194:845–8; discussion 848–9. CrossRef
- Guth AA, Mercado C, Roses DF, Darvishian F, Singh B, Cangiarella JF. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9. CrossRef
- Intra M, Zurrida S, Maffini F, Sonzogni A, Trifirò G, Gennari R, et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5. CrossRef
- Katz A, Gage I, Evans S, Shaffer M, Fleury T, Smith FP, et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2006;191:761–6. CrossRef
- Klauber-DeMore N, Tan LK, Liberman L, Kaptain S, Fey J, Borgen P, 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. 2000;7:636–42. CrossRef
- Parikh RR, Haffty BG, Lannin D, Moran MS. Ductal carcinoma in situ with microinvasion: prognostic implications, long-term outcomes, and role of axillary evaluation. Int J Radiat Oncol Biol Phys. 2010;82:7–13. CrossRef
- Sakr R, Barranger E, Antoine M, Prugnolle H, Daraï E, Uzan S. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J Surg Oncol. 2006;94:426–30. CrossRef
- Vieira CC, Mercado CL, Cangiarella JF, Moy L, Toth HK, Guth AA. Microinvasive ductal carcinoma in situ: clinical presentation, imaging features, pathologic findings, and outcome. Eur J Radiol. 2010;73:102–7. CrossRef
- 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;125:1298–301 (discussion 1301–2). CrossRef
- Zavagno G, Belardinelli V, Marconato R, Carcoforo P, Franchini Z, Scalco G, et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast. 2007;16:146–51. CrossRef
- Moore KH, Sweeney KJ, Wilson ME, Goldberg JI, Buchanan CL, Tan LK, et al. Outcomes for women with ductal carcinoma-in-situ and a positive sentinel node: a multi-institutional audit. Ann Surg Oncol. 2007;14:2911–7. CrossRef
- Wong SL, Chao C, Edwards MJ, Carlson DJ, Laidley A, Noyes RD, et al. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg. 2002;184:492–8 (discussion 498). CrossRef
- Zavotsky J, Hansen N, Brennan MB, Turner RR, Giuliano AE. Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer. 1999;85:2439–43. CrossRef
- Wasserberg N, Morgenstern S, Schachter, Fenig E, Lelcuk S, Gutman H. Risk factors for lymph node metastases in breast ductal carcinoma in situ with minimal invasive component. Arch Surg. 2002;137:1249–52. CrossRef
- AJCC Cancer Staging Handbook. New York: Springer; 2009.
- Hill AD, Tran KN, Akhurst T, Yeung H, Yeh SD, Rosen PP, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg. 1999;229:528–35. CrossRef
- Cody HS, 3rd, Borgen PI. State-of-the-art approaches to sentinel node biopsy for breast cancer: study design, patient selection, technique, and quality control at Memorial Sloan-Kettering Cancer Center. Surg Oncol. 1999;8:85–91. CrossRef
- Hoda SA, Chiu A, Prasad ML, Giri D, Hoda RS. Are microinvasion and micrometastasis in breast cancer mountains or molehills? Am J Surg. 2000;180:305–8. CrossRef
- Bianchi S, Vezzosi V. Microinvasive carcinoma of the breast. Pathol Oncol Res. 2008;14:105–11. CrossRef
- Schuh ME, Nemoto T, Penetrante RB, Rosner D, Dao TL. Intraductal carcinoma. Analysis of presentation, pathologic findings, and outcome of disease. Arch Surg. 1986;121:1303–7. CrossRef
- Rosner D, Lane WW, Penetrante R. Ductal carcinoma in situ with microinvasion. A curable entity using surgery alone without need for adjuvant therapy. Cancer. 1991;67:1498–503. CrossRef
- van la Parra RF, Ernst MF, Barneveld PC, Broekman JM, Rutten MJ, Bosscha K. The value of sentinel lymph node biopsy in ductal carcinoma in situ (DCIS) and DCIS with microinvasion of the breast. Eur J Surg Oncol. 2008;34:631–5. CrossRef
- Silver SA, Tavassoli FA. Mammary ductal carcinoma in situ with microinvasion. Cancer. 1998;82:2382–90. CrossRef
- Mann GB, Port ER, Rizza C, Tan LK, Borgen PI, Van Zee KJ. Six-year follow-up of patients with microinvasive, T1a, and T1b breast carcinoma. Ann Surg Oncol. 1999;6:591–8. CrossRef
- Solin LJ, Fowble BL, Yeh IT, Kowalyshyn MJ, Schultz DJ, Weiss MC, 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. CrossRef
- Dowlatshahi K, Fan M, Snider HC, Habib FA. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer. 1997;80:1188–97. CrossRef
- Tan LK, Giri D, Hummer AJ, Panageas KS, Brogi E, Norton L, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol. 2008;26:1803–9. CrossRef
- de Boer M, van Deurzen CH, van Dijck JA, Borm GF, van Diest PJ, Adang EM, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009;361:653–63. CrossRef
- Giuliano AE, Hawes D, Ballman KV, Whitworth PW, Blumencranz PW, Reintgen DS, et al. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. JAMA. 2011;306:385–93. CrossRef
- Weaver DL, Ashikaga T, Krag DN, Skelly JM, Anderson SJ, Harlow SP, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21. CrossRef
- Julian TB AS, Golesorkhi N, Fourchotte V, Mamounas EP, Wolmark N. Prospective outcomes for patients with micrometastases and macrometastases in sentinel nodes: NSABP B-32 sentinel node trial. Oral presentation. Cancer Res. 2010;70(24 Suppl):Abstract nr S5-1.
- Murphy CD, Jones JL, Javid SH, Michaelson JS, Nolan ME, Lipsitz SR, et al. Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion? Am J Surg. 2008;196:566–8. CrossRef
- Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32; discussion 432–3.
- Pugliese M, Stempel M, Patil S, Hsu M, Ho A, Traina T, et al. The clinical impact and outcomes of immunohistochemistry-only metastasis in breast cancer. Am J Surg. 2010;200:368–73. CrossRef
- Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717. CrossRef
- Pimiento JM, Lee MC, Esposito NN, Kiluk JV, Khakpour N, Carter B, et al. Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Pract. 2011;7:309–13. CrossRef
- Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19:212–6. CrossRef
- Axillary Node Staging for Microinvasive Breast Cancer: Is It Justified?
Annals of Surgical Oncology
Volume 19, Issue 11 , pp 3416-3421
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors