Abstract
Background
When ductal carcinoma in situ (DCIS) is found on core biopsy, histological underestimation can occur due to sampling error. When an invasive cancer is subsequently found, another operation is required for nodal staging. Sentinel lymph node biopsy (SLNB) enables nodal staging at the same operation. We examine the value of SLNB in patients with a preoperative diagnosis of DCIS focusing on the need for reoperation.
Methods
Patients with a preoperative core biopsy of DCIS underwent SLNB at the time of definitive surgery. The results of SLNB in relation to histological upstaging were analyzed.
Results
One hundred and seven patients with a core biopsy diagnosis of DCIS underwent simultaneous SLNB at the time of definitive surgery. SLNB was successful in 103 patients (96.3%) and 12 (11.7%) had SLN metastases. Thirty-two patients (29.9%) had histological upstaging and SLN was positive in nine (28.1%). Seventy-five patients had “pure DCIS” but three (4%) had SLN metastases. The presence of a palpable mass and radiological mass lesion were associated with histological upstaging. If SLNB were not performed, 32 patients (29.9%) with upstaging would require another surgery to stage the axilla. In the present series, 84% of these patients had appropriate axillary staging without the need for a second operation.
Conclusion
Underestimation of invasive disease was frequent on core biopsy. Performing SLNB during definitive surgery allowed correct nodal staging in a single operation. SLN metastasis was rare in patients with “pure DCIS” on final pathology. However, additional systemic treatment may be indicated for patients with SLN micrometastases.
Similar content being viewed by others
References
Yen T, 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.
Pendas S, Dauway E, Giuliano R, Ku NN, Cox CE, Reintgen DS. Sentinel node biopsy in DCIS patients. Ann Surg Oncol. 2000;7:15–20.
Pendas S, Jakub J, Giuliano R, Gardner M, Swor GB, Reintgen DS. The role of sentinel lymph node biopsy in patients with ductal carcinoma in situ or with locally advanced breast cancer receiving neoadjuvant chemotherapy. Cancer Control. 2004;11(4):231–5.
Hung WK, Chan CM, Ying M, Chong SF, Mak KL, Yip AW. Randomized clinical trial comparing blue dye with combined dye and isotope for sentinel lymph node biopsy in breast cancer. Br J Surg. 2005;92(12):1494–7.
Barros AC, Barros MA, Andrade FE, et al. Combined radioguided nonpalpable lesion localization and sentinel lymph node biopsy for early breast carcinoma. Ann Surg Oncol. 2007;14(4):1472–7.
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.
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.
Intra M, Veronesi P, Mazzarol G, et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg. 2003;138(3):309–13.
Wilkie C, White L, Dupont E, Cantor A, Cox CE. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg. 2005;190:563–6.
Zavagno G, Carcoforo P, Marconato R, et al. Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. BMC Cancer. 2005;5:28.
Camp R, Feezor R, Kasraeian A, et al. Sentinel lymph node biopsy for ductal carcinoma in situ: an evolving approach at the University of Florida. Breast J. 2005;11(6):394–7.
Mittendorf EA, Arciero CA, Gutchell V, Hooke J, Shriver CD. Core biopsy diagnosis of ductal carcinoma in situ: an indication for sentinel lymph node biopsy. Curr Surg. 2005;62(2):253–7.
Tan JC, McCready DR, Easson AM, Leong WL. Role of sentinel lymph node biopsy in ductal carcinoma-in situ treated by mastectomy. Ann Surg Oncol. 2007;14(2):638–45.
Ansari B, Ogston SA, Purdie CA, Adamson DJ, Brown DC, Thompson AM. Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast. Br J Surg. 2008;95(5):547–54.
Goyal A, Douglas-Jones A, Monypenny I, Sweetland H, Stevens G, Mansel RE. Is there a role of SLNB in DCIS? Analysis of 587 cases. Breast Cancer Res Treat. 2006;98(3):311–4.
Huo L, Sneige N, Hunt KK, Albarracin CT, Lopez A, Resetkova E. Predictors of invasion in patients with core-needle biopsy-diagnosed ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy in ductal carcinoma in situ. Cancer. 2006;107(8):1760–8.
Meijnen P, Oldenburg HSA, Loo CE, Nieweg OE, Peterse JL, Rutgers EJT. Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core-needle biopsy. Br J Surg. 2007;94:952–6.
Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomized trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.
Lagios MD, Silverstein MJ. Sentinel node biopsy for patients with DCIS: a dangerous and unwarranted direction. Ann Surg Oncol. 2001;8:275–7.
Moore KH, Thaler HT, Tan LK, Borgen PI, Cody HS. Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma: biologic metastasis or procedural artifact? Cancer. 2004;100:929–34.
Carter BA, Jensen RA, Simpson JF, Page DL. Benign transport of breast epithelium into axillary lymph nodes after biopsy. Am J Clin Pathol. 2000;113:259–65.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Hung, W.K., Ying, M., Chan, M. et al. The impact of sentinel lymph node biopsy in patients with a core biopsy diagnosis of ductal carcinoma in situ. Breast Cancer 17, 276–280 (2010). https://doi.org/10.1007/s12282-009-0164-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12282-009-0164-2