Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer
Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Cox 31, Boston, MA 02114, USA. The American Journal of Surgery
(Impact Factor: 2.29).
06/2006; 191(6):761-6. DOI: 10.1016/j.amjsurg.2006.01.019
The purpose of this study was to determine the rates of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal carcinoma in situ (DCIS) or microinvasive breast cancer (MIC).
One hundred thirty patients underwent SLN mapping from 1998 to 2003 for DCIS or MIC.
One hundred nine patients with DCIS and 21 with MIC underwent SLN mapping. One patient with bilateral DCIS underwent 2 SLN procedures; therefore, the results of 131 SLN procedures are included. On hematoxylin and eosin (H&E) staining, 4 of 110 patients (3.6%) with DCIS had positive SLNs. Four additional patients had positive SLNs by IHC staining only (3.6%). Two of 8 patients underwent completion axillary dissection, and neither had additional involved nodes on completion axillary dissection. One of the 21 patients with MIC had positive SLNs by hematoxylin and eosin (H&E) (4.8%), and another had an involved SLN by IHC staining (4.8%). The patient with the positive SLN by H&E had 1 additional node on completion axillary dissection.
Rates of SLN positivity for patients with DCIS are modest, even in a high-risk population, and there is continuing uncertainty about its clinical importance.
Available from: Ümit Ince
- "102 1% Lee Moffitt Cancer Center, FL, USA  195 13%: 6.5% by H&E; 6.5% by IHC Lee Moffitt Cancer Center, FL, USA  559 5%: 1.5% by H&E, 3.5% by IHC University of Paris, France  110 6% Sibley Memorial Hospital, Washington DC, USA  110 7.2%: 3.6% by H&E; 3.6% by IHC Memorial Sloan Kettering Cancer Center  76 12% Acibadem University, Faculty of Medicine, Istanbul (present study) 40 5%: 2.5% by H&E, 2.5% by IHC The variation in SLN positivity may be attributed to evolution of sentinel node biopsy techniques, different preoperative diagnostic methods, variations in pathological examination including extent of tissue sampling and evaluation of the SLNs with H&E or IHC or both, and small patient numbers in some series  . Some reports doubled their node positivity frequencies by using IHC to detect SLN involvement   . In a study by Lata et al. , in 13% of the patients, SLNs were shown to be involved by tumor cells by IHC methods but no significant association with local, regional or distant recurrence was shown. "
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ABSTRACT: Introduction. 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. We therefore aimed to identify factors in a single institutional series to select patients who may benefit from SLNB.
Material and Methods. Patients, diagnosed with pure DCIS (n = 63) between July 2000 and March 2011, were reviewed. 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. Results. Median age was 51 (range, 30–79). Of 63 patients, 40 cases (63.5%) with pure DCIS underwent SLN, and 2 of them had a positive SLN (5%). In both 2 cases with SLN metastases, only one sentinel lymph node was involved with tumor cells. 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. Conclusion. In our series, we found a slightly higher rate of SLNB positivity in patients with pure DCIS than the large series reported elsewhere. This may either be due to the meticulous examination of SLNs by serial sectioning technique or due to our patient selection criteria or both.
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ABSTRACT: Oncological surgery of the breast has undergone changes from several aspects in the past 20 years. The primary reason has
been the introduction of a biological approach, cancer screening, development of the surgical technique and the daily use
of quality assurance principles. We are again witnessing a paradigm change, the essence of which is that maximal radical treatment
is being replaced by minimal but sufficient surgical intervention. However, surgery remains determinant in the treatment of
KeywordsEarly breast cancer-Surgery
Available from: John P Hoffman
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Microinvasive breast carcinoma (MIC) has a good prognosis but specific definitions have varied in the past, making the clinical significance of MIC a subject of debate.METHODS
Microscopic slides of 59 cases of breast carcinoma originally diagnosed as MIC were reviewed retrospectively. Histologic parameters were correlated with clinical findings and outcome to define diagnostic criteria better.RESULTSOn review, the 59 cases were recategorized as follows: pure DCIS (N = 16), DCIS with foci equivocal for microinvasion (N = 7), DCIS with ≥ 1 focus of microinvasion (N = 11), T1 invasive carcinomas with ≥ 90% DCIS (N = 18), and T1 tumors with < 90% DCIS (N = 7). The MIC cases in the current study averaged 3 separate foci of early infiltration outside the basement membrane, each one not > 1.0 mm. The mean follow-up was 95 months. Six patients (10%) had only local recurrence: 1 case each in patients with equivocal microinvasion, microinvasion, and T1 tumors with < 90% DCIS and 3 cases among the patients with T1 tumors with ≥ 90% DCIS. Four patients, all with T1 tumors with ≥ 90% DCIS, had distant failure (7%). In the MIC group, only one patient developed a local recurrence after breast conservation. No patient had axillary lymph node metastasis. For the entire series, factors associated with local recurrence were younger age, breast conservation versus mastectomy, and close surgical margins. The only factor associated with distant failure was the size of the DCIS component. Seven patients with T1 tumors with ≥ 90% DCIS experienced local or distant failure and 5 of these (71%) developed progressive disease or died of disease. All other patients who developed a recurrence were disease free at last follow-up. In a retrospective series, poorer outcome in carcinomas with ≥ 90% DCIS may be related to the greater likelihood of missed larger areas of invasive carcinoma. Therefore, meticulous and extensive sampling of these carcinomas is required.CONCLUSIONSMIC as defined has a good prognosis. It has a different biology than T1 invasive carcinoma with ≥ 90% DCIS, which may progress and cause death. Large tumors with multiple foci of microinvasion may have metastatic potential. Cancer 2000;88:1403–9. © 2000 American Cancer Society.
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