Annals of Surgical Oncology

, Volume 14, Issue 2, pp 638–645

Role of Sentinel Lymph Node Biopsy in Ductal Carcinoma-in-situ Treated by Mastectomy

  • Jensen C. C. Tan
  • David R. McCready
  • Alexandra M. Easson
  • Wey L. Leong
Article

ABSTRACT

Background

Sentinel lymph node biopsy (SLNB) is a widely accepted alternative to axillary lymph node dissection in invasive breast cancer. Its role in ductal carcinoma-in-situ (DCIS) is unclear. The purpose of this study was to determine factors associated with the subsequent diagnosis of invasive disease and to determine the role of SLNB when performing a mastectomy for DCIS.

Methods

A retrospective study was conducted of all mastectomies performed on patients with a preoperative diagnosis of DCIS between 2000 and 2005 at a single tertiary-care institution.

Results

Ninety mastectomies for DCIS were included, 54 (60%) of which were performed with concurrent SLNB. Of 44 patients diagnosed preoperatively with DCIS by core biopsy only, 34 patients (63%) had a concurrent SLNB, while 10 patients (28%) were treated with mastectomy alone (P < .01). Overall, 30 patients (33%) had invasive disease, 22 of whom received concurrent SLNB. Seven SLNB patients (13%) had positive SLNs. On univariate analysis, multifocality (P = .03), multicentricity (P = .01), comedonecrosis (P = .01), and diagnosis by core biopsy (P < .001) were associated with invasive disease on pathology. On multivariate analysis, comedonecrosis (P = .04) and diagnosis by core biopsy (P < .01) were independent predictors for invasion. There was no statistically significant predictor for sentinel lymph node metastasis.

Conclusions

Approximately one-third of patients with DCIS treated with mastectomy at our institution later had invasive disease, and factors associated with invasion have been identified. On the basis of our results, routine SLNB is recommended in this patient population.

Keywords

Biopsy DCIS Mastectomy Sentinel lymph node 

References

  1. 1.
    Ersnter VL, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 2002; 94:1546–54Google Scholar
  2. 2.
    Silverstein MJ, Skinner KA, Lomis TJ. Predicting nodal positivity in 2282 patients with breast carcinoma. World J Surg 2001; 25:767–72PubMedCrossRefGoogle Scholar
  3. 3.
    Kelly TA, Kim JA, Patrick R, Grundfest S, Crowe JP. Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ. Am J Surg 2003; 186:368–70PubMedCrossRefGoogle Scholar
  4. 4.
    Yen WF, 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; 200:516–26PubMedCrossRefGoogle Scholar
  5. 5.
    Cox CE, Nguyen K, Gray RJ, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg 2001; 67:513–21PubMedGoogle Scholar
  6. 6.
    Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a radomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333:1456–61PubMedCrossRefGoogle Scholar
  7. 7.
    Giuliano AE. Mapping a pathway for axillary staging: a personal perspective on the current status of sentinel lymph node dissection for breast cancer. Arch Surg 1999; 134:195–9PubMedCrossRefGoogle Scholar
  8. 8.
    Adamovich TL, Simmons RM. Ductal carcinoma with microinvasion. Am J Surg 2003; 186:112–6PubMedCrossRefGoogle Scholar
  9. 9.
    Intra M, Zurrida S, Maffini F, et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol 2003; 10:1160–5PubMedCrossRefGoogle Scholar
  10. 10.
    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 2002; 7:636–42CrossRefGoogle Scholar
  11. 11.
    Farkas EA, Stolier AJ, Teng SC, Bolton JS, Fuhrman GM. An argument against routine sentinel node mapping for DCIS. Am Surg 2004; 70:13–8PubMedGoogle Scholar
  12. 12.
    Fuhrman GM. Sentinel lymph node mapping and biopsy for ductal carcinoma in situ and other controversial indications. Am Surg 2004; 70:403–6PubMedGoogle Scholar
  13. 13.
    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; 138:309–13PubMedCrossRefGoogle Scholar
  14. 14.
    Kuerer HM, Newman LA. Lymphatic mapping and sentinel lymph node biopsy for breast cancer: developments and resolving controversies. J Clin Oncol 2005; 23:1698–705PubMedCrossRefGoogle Scholar
  15. 15.
    McMasters KM, Chao C, Wong SL, Martin RCG, Edwards MJ. Sentinel lymph node biopsy in patients with ductal carcinoma in situ: a proposal. Cancer 2002; 95:15–20PubMedCrossRefGoogle Scholar
  16. 16.
    McCready DR, Yong WS, Ng AKT, Miller N, Done S, Youngson B. Influence of the new AJCC breast cancer staging system on sentinel lymph node positivity and false-negative rates. J Natl Cancer Inst 2004; 96:873–5PubMedCrossRefGoogle Scholar
  17. 17.
    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; 73:664–7Google Scholar
  18. 18.
    Silverstein MJ, Gierson ED, Colburn WJ, Rosser RJ, Waisman JR, Gamagami P. Axillary lymphadenectomy for intraductal carcinoma of the breast. Surg Gynecol Obstet 1991; 172:211–4PubMedGoogle Scholar
  19. 19.
    Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br J Cancer 1992; 66:136–8PubMedGoogle Scholar
  20. 20.
    Roses DF, Brooks AD, Harris MN, Shapiro RL, Mitnick J. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Surg 1999; 230:194–201PubMedCrossRefGoogle Scholar
  21. 21.
    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; 7:15–20PubMedCrossRefGoogle Scholar
  22. 22.
    Wong SL, Chao C, Edwards MJ, et al. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg 2002; 184:492–8PubMedCrossRefGoogle Scholar
  23. 23.
    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; 62:253–7PubMedCrossRefGoogle Scholar
  24. 24.
    Wasserberg N, Morgenstern S, Schachter J, 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; 137:1249–52PubMedCrossRefGoogle Scholar
  25. 25.
    Cserni G. Sentinel lymph node biopsy as a tool for the staging of ductal carcinoma in situ in patients with breast carcinoma. Surg Today 2002; 32:99–103PubMedCrossRefGoogle Scholar
  26. 26.
    Cserni G. Evaluation of sentinel lymph nodes in breast cancer. Histopathology 2005; 46:697–706PubMedCrossRefGoogle Scholar
  27. 27.
    Tamhane R, Dahlstrom JE, McCallum DD, Buckingham JM. The clinical significance of cytokeratin-positive cells in lymph nodes at the time of mastectomy from patients with ductal carcinoma-in-situ. Ann Surg Oncol 2002; 9:999–1003PubMedCrossRefGoogle Scholar
  28. 28.
    El-Tamer M, Chun J, Gill M, et al. Incidence and clinical significance of lymph node metastasis detected by cytokeratin immunohistochemical staining in ductal carcinoma in situ. Ann Surg Oncol 2005; 12:254–9PubMedCrossRefGoogle Scholar
  29. 29.
    Cserni G, Gregori D, Merletti F, et al. Meta-analysis of nonsentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg 2004; 91:1245–52PubMedCrossRefGoogle Scholar
  30. 30.
    Lara JF, Young SM, Velilla RE, Santoro EJ, Templeton SF. The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. Cancer 2003; 98:2105–13PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Jensen C. C. Tan
    • 1
  • David R. McCready
    • 2
  • Alexandra M. Easson
    • 2
  • Wey L. Leong
    • 2
    • 3
  1. 1.Division of General Surgery, Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Department of Surgical OncologyUniversity Health Network, University of TorontoTorontoCanada
  3. 3.General Surgery and Surgical OncologyPrincess Margaret Hospital, University Health NetworkTorontoCanada

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