Skip to main content
SpringerLink
Log in

DCIS and Sentinel Lymph Node Biopsy

  • Chapter
  • First Online:
Ductal Carcinoma In Situ and Microinvasive/Borderline Breast Cancer

  • 1232 Accesses

Abstract

This article provides evidence-based guidelines for the appropriate management of the sentinel lymph node (SLN) in patients with ductal carcinoma in situ (DCIS). Invasive cancer can often be intimately associated with DCIS. With minimally invasive core biopsy techniques, 20 % of preoperatively diagnosed DCIS will be upstaged to invasive cancer on final pathology. The clinician must consider a patient’s chances of having an invasive malignancy concealed in an area of DCIS. Palpable tumor and large mammographic DCIS size > 5 cm are the most consistent predictors of underlying invasive cancer and metastasis to SLNs. DCIS with microinvasion (DCISM) parallels DCIS with respect to risk for identification of nodal metastases. However, identification of isolated tumor cells (ITCs) or micrometastases in the SLN may lead to overtreatment. When local excision is performed for DCIS, SLN biopsy is possible as a subsequent procedure if invasion is identified on final pathology. Several meta-analyses have reported SLN positivity rates for pure DCIS between 3 and 4 %. In patients with pure DCIS, lymph node status failed to predict inferior outcomes and hence should not change subsequent management. Therefore, local control should be the goal for treatment of DCIS and systemic treatment targeted to the biology of any invasive component.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fuhrman GM. Pro: SLNB in DCIS. Ann Surg Oncol. 2007;14(3):1005–6.

    Article  PubMed  Google Scholar 

  2. 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(4):516–26.

    Article  PubMed  Google Scholar 

  3. 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(9):636–42.

    Article  CAS  PubMed  Google Scholar 

  4. Wilkie C, White L, Dupont E, et al. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg. 2005;190(4):563–6.

    Article  PubMed  Google Scholar 

  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(6):513–9.

    CAS  PubMed  Google Scholar 

  6. Yi M, Krishnamurthy S, Kuerer HM, et al. Role of primary tumor characteristics in predicting positive sentinel lymph nodes in patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2008;196(1):81–7.

    Article  PubMed  Google Scholar 

  7. Guillot E, Vaysse C, Goetgeluck J, et al. Extensive pure ductal carcinoma in situ of the breast: identification of predictors of associated infiltrating carcinoma and lymph node metastasis before immediate reconstructive surgery. Breast. 2014;23(2):97–103.

    Article  CAS  PubMed  Google Scholar 

  8. Lee SK, Yang JH, Woo SY, Lee JE, Nam SJ. Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg. 2013;100(13):1756–63.

    Article  CAS  PubMed  Google Scholar 

  9. Moore KH, Sweeney KJ, Wilson ME, et al. Outcomes for women with ductal carcinoma-in-situ and a positive sentinel node: a multi-institutional audit. Ann Surg Oncol. 2007;14(10):2911–7.

    Article  PubMed  Google Scholar 

  10. Intra M, Rotmensz N, Veronesi P, et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast: the experience of the European institute of oncology on 854 patients in 10 years. Ann Surg. 2008;247(2):315–9.

    Article  PubMed  Google Scholar 

  11. Cody HS 3rd. Sentinel lymph node biopsy for DCIS: are we approaching consensus? Ann Surg Oncol. 2007;14(8):2179–81.

    Article  PubMed  Google Scholar 

  12. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: american society of clinical oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83.

    Article  PubMed  Google Scholar 

  13. Veronesi P, Intra M, Vento AR, et al. Sentinel lymph node biopsy for localized ductal carcinoma in situ. Breast 2005;14:520–2.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Kelly TA, Kim JA, Patrick R, et al. Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ. Am J Surg. 2003;186:368–70.

    Article  PubMed  Google Scholar 

  16. Farkas EA, Stolier AJ, Teng SC, et al. An argument against routine sentinel node mapping for DCIS. Am Surg. 2004:70:876–80.

    Google Scholar 

  17. Mittendorf ME, Arciero CA, Gutchell V, et al. Core biopsy diagnosis of ductal carcinoma in situ: an indication for sentinel lymph node biopsy. Curr Surg. 2005:62:253–7.

    Article  PubMed  Google Scholar 

  18. Cserni G, Boross G, Maraz R, et al. Sentinel lymph node biopsy for in situ carcinoma of the breast. Experience at the Bacs-Kiskun County Hospital and review of the literature. Magy Seb. 2006;59:164–72.

    PubMed  Google Scholar 

  19. Mabry H, Giuliano AE, Silverstein MJ. What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ. Am J Surg. 2006;192:455–7.

    Article  PubMed  Google Scholar 

  20. Katz A, Gage I, Evans S, et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2006;191:761–6.

    Article  PubMed  Google Scholar 

  21. Sakr R, Barranger E, Antoine M, et al. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J Surg Oncol. 2006:94:426–30.

    Article  PubMed  Google Scholar 

  22. Fraile M, Gurben JM, Rull M, et al. Is it possible to refine the indication for sentinel node biopsy in high-risk ductal carcinoma in situ. Nucl Med Commun. 2006:94:380–4.

    Google Scholar 

  23. Ansari B, Ogston SA, Purdie CA, et al. Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast. Br J Surg. 2008;95(5):547–54.

    Article  CAS  PubMed  Google Scholar 

  24. van Deurzen CH, Hobbelink MG, van Hillegersberg R, et al. Is there an indication for sentinel node biopsy in patients with ductal carcinoma in situ of the breast? A review. Eur J Cancer. 2007;43(6):993–1001.

    Article  PubMed  Google Scholar 

  25. 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(1):15–20.

    Article  CAS  PubMed  Google Scholar 

  26. Lee LA, Siverstein MJ, Chung CT, et al. Breast cancer-specific mortality after invasive local recurrence in patients with ductal carcinoma in situ of the breast. Am J Surg. 2006;192(4):416–9.

    Article  PubMed  Google Scholar 

  27. International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet. 1990;335(8705):1565–8.

    Google Scholar 

  28. Gojon H, Fawunmi D, Valachis A. Sentinel lymph node biopsy in patients with microinvasive breast cancer: a systematic review and meta-analysis. Eur J Surg Oncol. 2014;40(1):5–11.

    Article  CAS  PubMed  Google Scholar 

  29. Gray RJ, Mulheron B, Pockaj BA, et al. The optimal management of the axillae of patients with mircoinvasive breast cancer in the sentinel lymph node era. Am J Surg. 2007;194:845–8.

    Article  PubMed  Google Scholar 

  30. Sakr R, Antoine M, Barranger E, et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma. Breast J. 2008;14:55–60.

    Article  PubMed  Google Scholar 

  31. Intra M, Zurrida S, Maffini F, et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5.

    Article  PubMed  Google Scholar 

  32. Ross DS, Hoda SA. Microinvasive (T1mic) lobular carcinoma of the breast: clinicopathologic profile of 16 cases. Am J Surg Pathol. 2011;35:75–6.

    Article  Google Scholar 

  33. Takacs T, Paszt A, Szentpali K, et al. Importance of sentinel lymph node biopsy in surgical therapy of in situ breast cancer. Pathol Oncol Res. 2009;15:329–33.

    Article  PubMed  Google Scholar 

  34. 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  PubMed  Google Scholar 

  35. Zavagno G, Belardinelli V, Marconato R, et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast. 2007;16:146–51.

    Article  PubMed  Google Scholar 

  36. Zavotsky J, Hansen N, Brennan MB, et al. Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer. 1999;85:2439–43.

    Article  CAS  PubMed  Google Scholar 

  37. 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  PubMed Central  PubMed  Google Scholar 

  38. Cserni G, Bianchi S, Vezzosi V, et al. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study. Pathol Oncol Res. 2007;13:5–14.

    Article  PubMed  Google Scholar 

  39. Meretoja TJ, Heikkila PS, Salmenkivi K, et al. Outcome of patients with ductal carcinoma in situ and sentinel node biopsy. Ann Surg Oncol. 2012;19:2345–51.

    Article  CAS  PubMed  Google Scholar 

  40. Lyons 3rd JM, Stempel M, Van Zee KJ, et al. Axillary node staging for microinvasive breast cancer: is it justified? Ann Surg Oncol. 2012;19:3416–21.

    Article  PubMed  Google Scholar 

  41. Le Bouedec G, de Lapasse C, Mishellany F, et al. Ductal carcinoma in situ of the breast with microinvasion. Role of sentinel lymph node biopsy. Gynecol Obstet Fertil. 2007;35:317–22.

    Article  CAS  PubMed  Google Scholar 

  42. 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  PubMed  Google Scholar 

  43. Lyman GH, Giuliano AE, Somerfield MR, et al. American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703–20.

    Article  PubMed  Google Scholar 

  44. Parikh RR, Haffty BG, Lannin D, et al. Ductal carcinoma in situ with microinvasion: prognostic implications, long-term outcomes, and role of axillary evaluation. Int J Radiat Oncol Biol Phys. 2012;82(1):7–13.

    Article  PubMed  Google Scholar 

  45. Murphy CD, Jones JL, Javid SH, 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(4):566–8.

    Article  PubMed  Google Scholar 

  46. Cody 3rd HS, Van Zee KJ. Point: sentinel lymph node biopsy is indicated for patients with DCIS. J Natl Compr Canc Netw. 2003;1(2):199–206.

    PubMed  Google Scholar 

  47. Lara JF, Young SM, Velilla RE, et al. The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. Cancer. 2003;98(10):2015–13.

    Article  Google Scholar 

  48. Bleiweiss IJ, Nagi CS, Jaffer S. Axillary sentinel lymph nodes can be falsely positive due to iatrogenic displacement and transport of benign epithelial cells in patients with breast carcinoma. J Clin Oncol. 2006;24(13):2013–8.

    Article  PubMed  Google Scholar 

  49. Francis AM, Grimes LM, Yi M, et al. Utility of sentinel lymph node dissection (SLND) in ductal carcinoma in situ (DCIS). Abstract Society of Surgical Oncology 66th annual cancer symposium. National Harbor, Maryland, 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77030, Houston, TX, USA

    Alfred J. Colfry III MD, Alastair M. Thompson ALCM, BSc (Hons), MBChB, MD, FRCSEd (Gen) & Henry Mark Kuerer MD, PhD, FACS

Authors
  1. Alfred J. Colfry III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alastair M. Thompson ALCM, BSc (Hons), MBChB, MD, FRCSEd (Gen)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry Mark Kuerer MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry Mark Kuerer MD, PhD, FACS .

Editor information

Editors and Affiliations

  1. Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan, USA

    Lisa A. Newman

  2. Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan, USA

    Jessica M. Bensenhaver

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Colfry, A., Thompson, A., Kuerer, H. (2015). DCIS and Sentinel Lymph Node Biopsy. In: Newman, L., Bensenhaver, J. (eds) Ductal Carcinoma In Situ and Microinvasive/Borderline Breast Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2035-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2035-8_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2034-1

  • Online ISBN: 978-1-4939-2035-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation