Role of sentinel lymph node biopsy in high-risk ductal carcinoma in situ patients

Moran, Cathal J.; Kell, Malcolm R.; Flanagan, Fidelma L.; Kennedy, Maria; Gorey, Thomas F.; Kerin, Michael J.

doi:10.1016/j.amjsurg.2006.11.027

« Previous Next »The American Journal of Surgery
Volume 194, Issue 2 , Pages 172-175, August 2007

Role of sentinel lymph node biopsy in high-risk ductal carcinoma in situ patients

Cathal J. Moran, F.R.C.S.I.
- Department of Surgery, National Breast Screening Program, Eccles Unit, University College Dublin, 36 Eccles St, Dublin 7, Ireland
Malcolm R. Kell, M.D., F.R.C.S.I.
- Department of Surgery, National Breast Screening Program, Eccles Unit, University College Dublin, 36 Eccles St, Dublin 7, Ireland
- Corresponding author. Tel.: +353-1-882-6200; fax: +353-1-882-6225.
Fidelma L. Flanagan, M.D., F.R.C.R.
- Department of Radiology, National Breast Cancer Screening Program, Eccles Unit, University College Dublin, Mater Misericordiae University Hospital, 36 Eccles St, Dublin 7, Ireland
Maria Kennedy, M.R.C.Path
- Department of Pathology, National Breast Cancer Screening Program, Eccles Unit, University College Dublin, Mater Misericordiae University Hospital, 36 Eccles St, Dublin 7, Ireland
Thomas F. Gorey, M.Ch., F.R.C.S.I.
- Department of Surgery, National Breast Screening Program, Eccles Unit, University College Dublin, 36 Eccles St, Dublin 7, Ireland
Michael J. Kerin, M.Ch., F.R.C.S.I.
- Department of Surgery, National Breast Screening Program, Eccles Unit, University College Dublin, 36 Eccles St, Dublin 7, Ireland

Received 11 April 2006; received in revised form 7 November 2007 published online 30 May 2007.

Abstract

Background

The role of sentinel lymph node biopsy (SLNB) for ductal carcinoma in situ (DCIS) is poorly defined. However, up to 20% of patients with DCIS will have invasive carcinoma; these patients require staging for axillary metastasis. The aim of this study was to identify patients with a core biopsy diagnosis of DCIS who may benefit from SLNB.

Methods

In a prospective study, we performed SLNB on patients with a preoperative diagnosis of >2.5 cm of high-grade DCIS or DCIS when mastectomy was indicated.

Results

Sixty-two patients underwent surgery for high-grade DCIS, and 35 of these patients underwent SLNB. Postsurgical excision histology revealed invasive disease in 20 patients, 19 of whom had undergone SLNB. Before the adoption of SLNB in selected DCIS patients, all 20 with occult invasive disease would have required second surgery axillary staging (P < .01, chi-square test).

Conclusions

SLNB should not be performed routinely for all patients with an initial diagnosis of DCIS. However, selective lymphadenectomy may be a useful clinical adjuvant in selected high-risk DCIS patients.

Keywords: Ductal carcinoma in situ, Sentinel, Lymph node, Biopsy