![]() ![]() ![]() In patients with invasive breast carcinoma, an SLN biopsy reduces the morbidity of axillary staging by minimizing lymphatic disruption 5 while increasing the accuracy of staging because it allows a thorough pathologic examination of the SLN. The sentinel lymph node (SLN) is the first node that receives lymphatic drainage from the primary tumor. Axillary dissection is not routinely indicated because of the low prevalence of nodal metastases, which is expected to be less than 2%, 4 and the significant morbidity associated with lymph node dissection. A total mastectomy can be required in cases of extensive intramammary spread. Standard treatment of DCIS is wide resection, with or without postoperative radiotherapy. Pure DCIS showed a 15-fold increase during the past 10 years, because of the widespread use of mammography for the detection of clinically nonpalpable tumors now, it accounts for 20% or more of mammographically detected carcinomas 1 - 3 and 12% of all newly diagnosed breast cancers. It usually presented as a palpable lesion, Paget disease, or bloody nipple discharge. PURE DUCTAL carcinoma in situ (DCIS) of the breast was infrequently diagnosed in the past, when it accounted for only 1% to 5% of all breast cancers. Complete axillary dissection may not be mandatory if the SLN is micrometastatic. It could be considered in patients with DCIS undergoing mastectomy, in whom there exists a higher risk of harboring an invasive component using definitive histologic features, like large solid tumors or diffuse or multicentric microcalcifications in these patients, an SLN biopsy cannot be performed at a later operation. In patients with pure DCIS in whom the lesion is completely excised by radical surgery, an SLN biopsy could be avoided. Of these 7 patients, 5 had only micrometastases in the SLNs and in the 6 patients treated with complete axillary dissection, the SLN was the only positive node.Ĭonclusions Because of the low prevalence of metastases, an SLN biopsy should not be considered a standard procedure in all patients with DCIS. Results Metastases in the SLN were detected in 7 (3.1%) of the 223 patients, and complete axillary dissection was subsequently performed in all these patients but 1. Patients From January 1, 1998, to December 1, 2001, 223 unselected consecutive patients affected by pure DCIS of the breast underwent an SLN biopsy. Setting Department of breast surgery of a comprehensive cancer center. Hypothesis A sentinel lymph node (SLN) biopsy should not be considered a standard procedure in the treatment of all patients with ductal carcinoma in situ (DCIS) of the breast if the lesion is completely excised by radical surgery and there are free margins of resection. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment. ![]() Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.SLN biopsy for high-risk DCIS patients is a mean of detecting those who may have unrecognized invasive disease and therefore are at risk for distant disease. This patient had immunohistochemistry detected isolated tumor cells in her SLN (N0(i+)), and upon pathologic review, was found to have high-grade DCIS with microinvasion. At a median (range) follow-up of 27 (3-88) months, 1 patient had developed hepatic metastases. Nine of 43 (21%) high-risk DCIS patients with a positive SLN and 9/470 (2%) of all high-risk DCIS patients were upstaged to AJCC stage I or II as a result of the SLN biopsy. On pathological review of the primary lesion, 2 (5%) of 43 patints were found to have microinvasion, and 2 (5%) lymphovascular invasion. Of the 25 women that underwent completion axillary dissection, one was found to have a macrometastasis. Three (7%) of the 43 SLN-positive patients had macrometastases (pN1), 4 (9%) had micrometastases (pN1mi), and 36 (84%) had single tumor cells or small clusters (pN0(i+)). For these 414 patients, univariate analyses of tumor characteristics were performed to identify factors associated with node positivity.Įxtensive disease requiring mastectomy (p = 0.02) and the presence of necrosis (p = 0.04) were associated with an increased risk of nodal positivity. At 2 of the 3 institutions, data were also collected on DCIS patients who had negative findings on SLN biopsy. Pathology findings of positive cases were reviewed, and follow-up was obtained. SLN biopsy was performed on 470 high-risk patients with DCIS (22% of all patients with DCIS) at 3 institutions. Although it is well established that nodal status for invasive disease is prognostically important, the clinical relevance of a positive SLN in patients with DCIS remains undetermined. A positive sentinel lymph node (SLN) has been reported in 6% to 13% of patients with ductal carcinoma in situ (DCIS). ![]()
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