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Ductal Carcinoma In Situ with Microinvasion on Core Biopsy: Evaluating Tumor Upstaging Rate, Lymph Node Metastasis Rate, and Associated Predictive Variables

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

Abstract

Introduction

The role of sentinel lymph node biopsy (SLNB) when ductal carcinoma in situ with microinvasion (DCISM) is identified on core biopsy is unclear.

Objective

Our aim was to assess the upstage rate to invasive cancer and axillary lymph node metastasis in patients diagnosed with DCISM, and whether predictive variables could be identified that may help inform who would most likely benefit from a surgical axillary evaluation.

Methods

We performed a retrospective review of 70 patients diagnosed with DCISM on core biopsy. Patients with concomitant or prior invasive cancer were excluded. Demographic, clinical, radiographic, histologic, and treatment data were collected. Fisher’s exact test and univariable and multivariable logistic regression were performed to identify variables that may be associated with tumor upstaging and nodal metastasis. Time-to-event distributions were summarized using the Kaplan–Meier method.

Results

On final surgical pathology, 49 patients (70%) had a final diagnosis of DCISM or T1mi cancer, whereas 21 patients (30%) were upstaged to measurable invasive cancer (> 1 mm). One of 49 patients (2%) with DCISM on final pathology and 4 of 21 patients (19%) with measurable invasive cancer showed sentinel lymph node metastases.

Conclusion

Although the upstage rate to measurable invasive cancer in our cohort of patients with DCISM on core biopsy was 30%, findings of a positive SLNB remain low at 7%. No predictive variables were identified to inform whether the routine practice of SLNB may be omitted in some patients with DCISM.

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References

  1. Amin MB, American joint committee on cancer: AJCC Cancer staging manual. Basel: Springer; 2017.

    Book  Google Scholar 

  2. Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer. 1982;50:1309–14.

    Article  CAS  Google Scholar 

  3. National Comprehensive Cancer Network. Breast Cancer (Version 3.2018). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 7 Oct 2018.

  4. Dillon MF, McDermott EW, Quinn CM, et al. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol. 2006;93:559–63.

    Article  Google Scholar 

  5. Goyal A, Douglas-Jones A, Monypenny I, et al. Is there a role of sentinel lymph node biopsy in ductal carcinoma in situ? Analysis of 587 cases. Breast Cancer Res Treat. 2006;98:311–4.

    Article  Google Scholar 

  6. Hoorntje LE, Schipper ME, Peeters PH, et al. The finding of invasive cancer after a preoperative diagnosis of ductal carcinoma-in situ: causes of ductal carcinoma-in situ underestimates with stereotactic 14-gauge needle biopsy. Ann Surg Oncol. 2003;10:748–53.

    Article  Google Scholar 

  7. Kurniawan ED, Rose A, Mou A, et al. Risk factors for invasive breast cancer when core needle biopsy shows ductal carcinoma in situ. Arch Surg. 2010;145:1098–104.

    Article  Google Scholar 

  8. Moran CJ, Kell MR, Flanagan FL, et al. Role of sentinel lymph node biopsy in high-risk ductal carcinoma in situ patients. Am J Surg. 2007;194:172–175.

    Article  Google Scholar 

  9. Vieira CC, Mercado CL, Cangiarella JF, et al. Microinvasive ductal carcinoma in situ: clinical presentation, imaging features, pathologic findings, and outcome. Eur J Radiol. 2010;73:102–7.

    Article  Google Scholar 

  10. Yen TW, Hunt KK, Ross MI, et al. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ: a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ. J Am Coll Surg. 2005;200:516–26.

    Article  Google Scholar 

  11. American Cancer Society: Breast Cancer Facts & Figures 2017–2018. 2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf. Accessed 20 Apr 2018.

  12. Cox CE, Nguyen K, Gray RJ, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg. 2001;67:513–9; discussion 519–521.

  13. Kerlikowske K. Epidemiology of ductal carcinoma in situ. JNCI Monogr. 2010;2010:139–41.

    Article  Google Scholar 

  14. Klauber-DeMore N, Tan LK, 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. 2000;7:636–42.

    Article  CAS  Google Scholar 

  15. Namm JP, Mueller J, Kocherginsky M, Kulkarni S. The utility of sentinel lymph node biopsy in patients with ductal carcinoma in situ suspicious for microinvasion on core biopsy. Ann Surg Oncol. 2015;22:59–65.

    Article  Google Scholar 

  16. Pimiento JM, Lee MC, Esposito NN, et al. Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Pract. 2011;7:309–13.

    Article  Google Scholar 

  17. Tuttle TM, Shamliyan T, Virnig BA, Kane RL. The impact of sentinel lymph node biopsy and magnetic resonance imaging on important outcomes among patients with ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010:117–20.

    Article  Google Scholar 

  18. Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102:170–8.

    Article  Google Scholar 

  19. Lyons JM, Stempel M, Van Zee KJ, Cody HS. Axillary node staging for microinvasive breast cancer: is it justified? Ann Surg Oncol. 2012;19(11):3416–21.

    Article  Google Scholar 

  20. Kapoor NS, Shamonki J, Sim MS, Chung CT, Giuliano AE. Impact of multifocality and lymph node metastasis on the prognosis and management of microinvasive breast cancer. Ann Surg Oncol. 2013;20(8):2576–81.

    Article  Google Scholar 

  21. de Mascarel I, MacGrogan G, Mathoulin-Pélissier S, et al. Breast ductal carcinoma in situ with microinvasion. Cancer. 2002;94:2134–42.

    Article  Google Scholar 

  22. Guth AA, Mercado C, Roses DF, et al. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9.

    Article  Google Scholar 

  23. Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260(1):119–28.

    Article  Google Scholar 

  24. Jackman RJ, Burbank F, Parker SH et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001;218(2):497–502.

    Article  CAS  Google Scholar 

  25. Lee JW, Han W, KO E, et al. Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus. J Surg Oncol. 2008;98(1):15–20.

    Article  Google Scholar 

  26. Kim M, Kim, HJ, Chung YR, et al. Microinvasive carcinoma versus ductal carcinoma in situ: a comparison of clinicopathological features and clinical outcomes. J Breast Cancer. 2018;21(2):197–205.

    Article  Google Scholar 

  27. Matsen CB, Hirsch A, Eaton A, et al. Extent of microinvasion in ductal carcinoma in situ is not associated with sentinel lymph node metastases. Ann Surg Oncol. 2014;21:3330–5.

    Article  Google Scholar 

  28. Ko BS, Lim WS, Kim HJ, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19:212–6.

    Article  Google Scholar 

  29. Houssami N, Ambrogetti D, Marinovich ML et al. Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma-in situ on vacuum-assisted core needle biopsy. Ann Surg Oncol. 2011;18:1364–71.

    Article  Google Scholar 

  30. Park AY, Gweon HM, Son EJ, Yoo M, Kim JA, Youk JH. Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: preoperative predictors of invasive breast cancer. Eur J Radiol. 2014; 83(4):654–9.

    Article  Google Scholar 

  31. 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. 2012;82:7–13.

    Article  Google Scholar 

  32. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14:500–15.

    Article  Google Scholar 

  33. Shaitelman SF, Cromwell KD, Rasmussen JC, et al. Recent progress in cancer-related lymphedema treatment and prevention. CA Cancer J Clin. 2015;65:55-81.

    Article  Google Scholar 

Download references

Acknowledgment

The authors thank Geraldine M. Chadwick, AuD, who provided medical writing support on behalf of the Department of Surgery, Carolinas Medical Center.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA

    April Phantana-angkool MD, Amy E. Voci DO, Yancey E. Warren MD, Lakesha M. Beasley BA, Lejla Hadzikadic-Gusic MD, Terry Sarantou MD, Meghan R. Forster MD, Deba Sarma MD & Richard L. White Jr. MD, FACS

  2. Charlotte Pathology Group, Charlotte, NC, USA

    Chad A. Livasy MD

  3. Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC, USA

    Myra M. Robinson MSPH

Authors
  1. April Phantana-angkool MD
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Correspondence to Richard L. White Jr. MD, FACS.

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Phantana-angkool, A., Voci, A.E., Warren, Y.E. et al. Ductal Carcinoma In Situ with Microinvasion on Core Biopsy: Evaluating Tumor Upstaging Rate, Lymph Node Metastasis Rate, and Associated Predictive Variables. Ann Surg Oncol 26, 3874–3882 (2019). https://doi.org/10.1245/s10434-019-07604-4

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  • DOI: https://doi.org/10.1245/s10434-019-07604-4

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