Ductal carcinoma in situ: Value of sentinel lymph node biopsy

Department of Gynecology, Hôpital Tenon, Paris, France.
Journal of Surgical Oncology (Impact Factor: 3.24). 10/2006; 94(5):426-30. DOI: 10.1002/jso.20578
Source: PubMed


Ductal carcinoma in situ (DCIS) represents about 20% of newly diagnosed breast carcinomas. Axillary metastasis is often related to undiagnosed DCIS with microinvasion (DCISM). The aim of this study was to confirm the interest of sentinel lymph node (SLN) biopsy in extensive DCIS.
Patients with a diagnosis of DCIS or DCISM and axillary lymph node evaluation were selected. Surgical treatment included SLN biopsy and/or axillary lymph node dissection (ALND). Serial sections were stained with hematoxylin and eosin (H&E) and with an immunohistochemical (IHC) method. When a micrometastasis was found, the breast specimen was revised searching for occult microinvasion.
Hundred and forty patients with initial DCIS were enrolled in the study. Node metastasis was identified in 9 patients (7%) of the 128 patients with DCIS and DCISM. At final histology, 4 (10%) of the 39 patients with pure DCIS and SLN biopsy and 1 (7%) of the 14 patients with DCISM and SLN biopsy had axillary micrometastasis. Four of the 12 patients upstaged to invasive carcinoma had metastatic SLNs.
Sentinel lymph node biopsy is valuable in patients with diffuse DCIS or DCISM who are scheduled for mastectomy in order to search for axillary micrometastases and occult breast microinvasion.

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    • "The one case that was localized only on MRI and the patient underwent MRM was pure DCIS. Historically, the reported incidence of axillary metastasis in patients with DCIS is 1-2%, but the prevalence of positive lymph nodes in patients with pure DCIS is approximately 2-13% with performing immunohistochemical staining (15, 16). Node metastasis is usually observed in the sentinel lymph node only in patients with DCIS (17), but in our case, four lymph nodes were revealed to have malignant cells after MRM. "
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    ABSTRACT: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.
    Korean Journal of Radiology 10/2007; 8(5):382-9. DOI:10.3348/kjr.2007.8.5.382 · 1.57 Impact Factor
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    • "Gross or clinically evident DCIS, and DCIS that is suspicious for microinvasion are also circumstances in which invasive cancer is found frequently and where SLNB should be considered. When microinvasion is identified definitely at the time of biopsy, SLNB should be performed, because axillary metastases have been reported in 3% to 20% of such patients [91] [92] [93] [94] [95]. SLNB is not warranted in all patients who have DCIS because of the small but real morbidity of the procedure. "
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    ABSTRACT: This article summarizes the modern evidence-based management of ductal carcinoma in situ. The data addressing the surgical issues, including indications for mastectomy and the use of sentinel node biopsy, are presented. The randomized trials examining the role of radiation therapy after breast-conserving surgery and the use of tamoxifen in ductal carcinoma in situ are discussed. Factors to consider in developing a management strategy for the individual patient are elucidated in the final section.
    Surgical Clinics of North America 05/2007; 87(2):333-51, viii. DOI:10.1016/j.suc.2007.01.006 · 1.88 Impact Factor
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