DCIS SENTINEL NODE BIOPSY SERIAL
DCIS SENTINEL NODE BIOPSY SERIES

The decision on whether a SLNB was to be performed was made for each individual patient separately. The excisional biopsy technique to remove the nonpalpable lesion by ROLL has been described before in detail. The data regarding patient and tumor characteristics were collected form medical records: age at diagnosis, menopausal status, tumor size, nuclear grade, presence of comedo necrosis, type of biopsy (core biopsy, vacuum aspirated biopsy, excisional biopsy by wire-needle localisation or radioguided occult lesion localisation (ROLL)), type of breast surgery (mastectomy versus breast conservation), margin status, estrogen receptor (ER) staining, progesterone receptor (PR) staining, HER2/neu staining, presence of SLNB, and pathological examination of sentinel lymph nodes. Patients with DCIS associated with microinvasion ( n = 5) were excluded from the study, and 63 patients with pure DCIS were reviewed.

Of 699 patients operated for breast cancer at our institution between July 2000 and March 2011, 68 patients (9.7%) were diagnosed with pure DCIS or DCIS associated with microinvasion.

DCIS SENTINEL NODE BIOPSY SERIES

In the present study, we reviewed the patients with a definitive diagnosis of pure DCIS in a single institution series to identify factors to select patients who may benefit from SLNB, and to define our surgical management in these patients. Furthermore, presence of comedonecrosis and larger mammographic DCIS size were independent predictors of patients' undergoing SLNB with a presurgical diagnosis of DCIS in core biopsy. However, no risk factors could be found that were predictive for sentinel lymph node metastasis. Presence of high grade DCIS or presence of comedonecrosis, and diagnosis of invasive component by core-needle biopsy, and mammographic DCIS size of at least 4 cm were identified as independent risk factors for invasion. Many surgeons advocate SLNB for patients with DCIS in whom mastectomy was planned to avoid an unnecessary axillary clearance in case an invasive focus has been identified in the final pathology. However, the surgeon mostly has to decide on whether SLNB is to be performed based on a preoperative stereotactic core-needle biopsy or vacuum aspiration biopsy or tumor characteristics or surgery type. The flaw is that definitive diagnosis of DCIS cannot be made unless the final histopathological examination is done. However, there have been reports which discourage SLNB in patients with pure DCIS due to very low rate of axillary metastasis. In the era of sentinel lymph node biopsy (SLNB) which has been well established in early invasive breast cancer with low axillary recurrence, the center of argument in DCIS has become “to do or not to do SLNB in patients with DCIS?” Today, some authors still believe that there is a subset of patients at high risk for microinvasive disease and subsequent axillary metastasis who may benefit from the SLN biopsy (SLNB). Axillary dissection rates have been decreased since 1990s because it has been shown that omission of axillary dissection in patients with pure in situ disease had no adverse effect on survival or recurrence. So far the management of axilla in DCIS has dramatically changed.

DCIS SENTINEL NODE BIOPSY SERIAL

This may either be due to the meticulous examination of SLNs by serial sectioning technique or due to our patient selection criteria or both.ĭuctal carcinoma in situ (DCIS) of the breast is a preinvasive lesion with theoretically no potential for lymph node or distant metastases by definition. In our series, we found a slightly higher rate of SLNB positivity in patients with pure DCIS than the large series reported elsewhere. Patients who underwent SLNB were more likely to have a tumor size >30 mm or DCIS with intermediate and high nuclear grade or a mastectomy in univariate and multivariate analyses. In both 2 cases with SLN metastases, only one sentinel lymph node was involved with tumor cells. Of 63 patients, 40 cases (63.5%) with pure DCIS underwent SLN, and 2 of them had a positive SLN (5%).

All the sentinel lymph nodes were examined by serial sectioning (50 μm) of the entire lymph node and H&E staining, and by cytokeratin immunostaining in suspicious cases. Patients, diagnosed with pure DCIS ( n = 63) between July 2000 and March 2011, were reviewed. We therefore aimed to identify factors in a single institutional series to select patients who may benefit from SLNB. Sentinel lymph node biopsy (SLNB) in patients with pure ductal carcinoma in situ (DCIS) has been a matter of debate due to very low rate of axillary metastases.

Dcis sentinel node biopsy