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Liu Y, Wang X, Zheng A, Yu X, Jin Z, Jin F. Breast Lesions Diagnosed as Ductal Carcinoma In Situ by Ultrasound-Guided Core Needle Biopsy: Risk Predictors for Concomitant Invasive Carcinoma and Axillary Lymph Node Metastasis. Front Oncol 2021; 11:717198. [PMID: 34568047 PMCID: PMC8461168 DOI: 10.3389/fonc.2021.717198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background The major concern over preoperatively diagnosed ductal carcinoma in situ (DCIS) of breast via ultrasound-guided core needle biopsy (US-CNB) is the risk of missing concomitant invasive carcinoma. It is crucial to identify risk predictors for such a phenomenon and evaluate its impact on axillary conditions to help surgeons determine which patients should receive appropriate axillary lymph node management. Methods Medical records of 260 patients preoperatively diagnosed with DCIS via 14-gauge CNB were retrospectively analyzed. All of them underwent subsequent surgery at our institution and were successively divided into invasive and non-invasive groups, and metastatic and non-metastatic groups according to pathology of resected specimens and metastasis of axillary lymph nodes (ALNs). Predictive value of preoperative physical examinations, imaging findings, histopathological findings, and hematological indexes for pathological underestimation and metastasis of ALN was assessed by logistic regression analysis. Results The concomitant invasive carcinoma was overlooked in 75 out of 260 patients (29.3%). Multivariate analysis revealed that presence of microinvasion, presence of abnormal lymph node on ultrasound, and absent linear or segmental distributed calcification on mammography were independent risk predictors for invasive carcinoma. Fourteen patients had lymph node metastasis, and five of them were in the non-invasive group. The presence of abnormal lymph node on ultrasound and increased ratio of platelet distribution width to platelet crit (PDW/PCT) (>52.85) were identified as independent risk predictors for ALN metastasis. Conclusion For patients diagnosed with DCIS preoperatively, appropriate ALN management is necessary if they have risk predictors for concomitant invasive carcinoma and ALN metastasis.
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Affiliation(s)
- Yanbiao Liu
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Xu Wang
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Ang Zheng
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinmiao Yu
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Zining Jin
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
| | - Feng Jin
- Department of Breast Surgery, The 1st Affiliated Hospital, China Medical University, Shenyang, China
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Nicholson S, Hanby A, Clements K, Kearins O, Lawrence G, Dodwell D, Bishop H, Thompson A. Variations in the management of the axilla in screen-detected Ductal Carcinoma In Situ: Evidence from the UK NHS Breast Screening Programme audit of screen detected DCIS. Eur J Surg Oncol 2015; 41:86-93. [DOI: 10.1016/j.ejso.2014.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022] Open
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Sundara Rajan S, Verma R, Shaaban AM, Sharma N, Dall B, Lansdown M. Palpable ductal carcinoma in situ: analysis of radiological and histological features of a large series with 5-year follow-up. Clin Breast Cancer 2014; 13:486-91. [PMID: 24267733 DOI: 10.1016/j.clbc.2013.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 08/05/2013] [Accepted: 08/26/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Palpable pure DCIS is a rare entity that presents differently than screen-detected DCIS. The aim of this study was to evaluate the clinical, radiological, and pathological characteristics and management of pDCIS in a retrospective cohort of patients. PATIENTS AND METHODS Patients diagnosed with pDCIS from January 1999 to December 2011 were identified from an electronic patient database and were included in this study. RESULTS During this period, 669 cases of DCIS were diagnosed and 62 (9.3%) were pDCIS (mean age, 56.9 ± 15.1 years). The most common finding on ultrasound was mass in 43 patients (75%) and only 18 (33%) cases had calcification on mammography. The lesion was mammographically occult in 20 patients (37%). Ultrasound was more sensitive and delineated the pDCIS in 45 (80%) cases. Mean size of the pDCIS was 36.9 ± 30.4 mm and most were high grade (n = 42; 68%) and associated with comedo necrosis in 36 (59%). Most were oestrogen receptor (ER)-positive (n = 34; 62%), however 21 patients (38%) were ER-negative. Breast conservation was attempted in 30 patients (48%), however, because of involved margins further therapeutic surgery was needed in 10 patients (33%). Axillary surgery (sentinel lymph node biopsy or axillary nodal sampling) was performed in 34 patients (55%) and no lymph node metastasis was identified. During a medial follow-up of 60 months, 1 patient has developed a mastectomy scar recurrence and the rest remain disease-free. CONCLUSION Palpable DCIS is often occult on conventional radiological imaging and is generally associated with aggressive pathological features. Hence, careful individualized surgical planning through a multidisciplinary meeting is necessary for their management.
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Affiliation(s)
- Sreekumar Sundara Rajan
- Department of Breast Surgery, St. James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
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Masson S, Bahl A. The management of ductal carcinoma in situ: current controversies and future directions. Clin Oncol (R Coll Radiol) 2013; 25:275-82. [PMID: 23453783 DOI: 10.1016/j.clon.2013.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 11/30/2022]
Abstract
The incidence of ductal carcinoma in situ (DCIS) has increased in recent decades, primarily due to the widespread implementation of breast cancer screening. Traditionally, the management of DCIS has mirrored that of invasive breast cancer, with a focus on adequate surgical excision, breast-conserving surgery, adjuvant radiotherapy and endocrine therapy. However, an increasing understanding of the biology of this spectrum of conditions many mean that some cases may be managed more conservatively, reserving aggressive therapies for those patients at high risk of progression to invasive disease, ultimately aiming for a personalised approach based on individual risk factors. This overview highlights the key evidence behind current practice and discusses the rationale for current and future clinical trials in DCIS.
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Affiliation(s)
- S Masson
- Bristol Haematology and Oncology Centre, Bristol, UK.
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Gwak G, Lee HK, Kim HJ, Lee SY, Park YL, Lee JW, Kim SG, Huh H, Shin H, Kim JR, Ahn JS, Son JH, Lee IG, Park WC, Kim SY, Han S, Lee ES. Survey of the application of the korean clinical practice recommendations on breast cancer treatment: the utility of the korean breast cancer society guidelines. J Breast Cancer 2012; 15:239-43. [PMID: 22807943 PMCID: PMC3395749 DOI: 10.4048/jbc.2012.15.2.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/09/2012] [Indexed: 11/30/2022] Open
Abstract
This survey was performed to analyze the usability of the third edition of the Korean breast cancer clinical practice guidelines (KBCCPG) in clinical practice. We made a questionnaire composed of 18 general and 82 specific questions regarding benign breast disease (B; 1 question); non-invasive disease (N; 12 questions); early-stage disease (E; 26 questions); advanced disease (A; 24 questions); and metastatic (M) breast cancer-related problems (19 questions). A total of 100 questionnaires, with a link to an online survey, were delivered via e-mail to over 700 members of the Korean Breast Cancer Society (KBCS), and associated academy members, over 20 days between 26th February and 16th May 2010. Out of 270 respondents who read the e-mail, 96 answered the questionnaire. Participants included 87 surgical oncologists, 5 radiation oncologists, 2 oncoplastic surgeons, 1 pathologist, and 1 medical oncologist. The third KBCCPG were perceived as differing from the second guidelines in terms of the level of clinical evidence required before choosing a recommendation. For the progress of the KBCCPG, the guideline committee should try to reinforce all courses of guideline development with several elements including data from clinical trials of Korean breast cancer patients, securing a multidisciplinary approach, developing consistent and reasonable processes for each step of the revision of the guidelines, induction of liberal scientific and ethical discussion about all issues with all KBCS members. The cost-effectiveness of healthcare and the logical development of the KBCCPG would also be ensured. Timely updates of the clinical guidelines for breast cancer treatment are essential to facilitate optimal decision-making in daily practice, and to ensure adequate patient feedback.
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Affiliation(s)
- Geumhee Gwak
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
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Shah DR, Canter RJ, Khatri VP, Bold RJ, Martinez SR. Utilization of lymph node assessment in patients with ductal carcinoma in situ treated with lumpectomy. J Surg Res 2012; 177:e21-6. [PMID: 22482771 DOI: 10.1016/j.jss.2012.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/01/2012] [Accepted: 03/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Lymph node assessment (LNA), including sentinel lymph node biopsy (SLNB), is controversial in patients undergoing lumpectomy for ductal carcinoma in situ (DCIS). Our goal was to identify factors influencing LNA in these patients. METHODS We used the Surveillance Epidemiology and End Results database to identify all female patients treated with lumpectomy for DCIS from 2000 to 2008. We excluded patients without histologic confirmation, including those diagnosed at autopsy, and those for whom LNA status was unknown. Multivariate logistic regression models predicted use of LNA. Likelihood of undergoing LNA was reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 62,935 patients met inclusion criteria. Approximately 15% (N = 9726) had regional LNA at the time of lumpectomy, with 12% (N = 7294) undergoing SLNB. Factors associated with an increased likelihood of undergoing LNA included treatment in the Southeast (OR 1.25, CI 1.04-1.22); treatment after the year 2000; grade II (OR 2.71, CI 2.48-2.96), III (OR 2.38, CI 2.18-2.59), or IV (OR 2.61, CI 2.37-2.88) tumors; DCIS size 2-5 cm (OR 1.49, CI 1.37-1.62) or >5 cm (OR 2.16, CI 1.78-2.61), and estrogen receptor-negative (OR 1.29, CI 1.16-1.43) or progesterone receptor-negative (OR 1.22, CI 1.11-1.33) tumors. Factors associated with a decreased likelihood of undergoing regional LNA were age >60 (OR 0.83, CI 0.79-0.87), and Asian race (OR 0.88, CI 0.81-0.96). Factors predictive of LNA in general were also predictive of SLNB. CONCLUSIONS Although LNA is controversial for patients undergoing lumpectomy for DCIS, it is used in 15% of cases. Further research establishing for the benefit of LNA in DCIS patients treated with lumpectomy is needed.
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Affiliation(s)
- Dhruvil R Shah
- Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, California, USA
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Estévez LG, Álvarez I, Seguí MÁ, Muñoz M, Margelí M, Miró C, Rubio C, Lluch A, Tusquets I. Current perspectives of treatment of ductal carcinoma in situ. Cancer Treat Rev 2010; 36:507-17. [DOI: 10.1016/j.ctrv.2010.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/15/2010] [Accepted: 03/21/2010] [Indexed: 11/16/2022]
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8
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Carcinomes canalaires in situ (CCIS). Caractéristiques histopathologiques et traitement : analyse de 1 289 cas. Bull Cancer 2010; 97:301-10. [DOI: 10.1684/bdc.2010.1048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sentinel lymph node biopsy in two Burgundy districts: prospective multicentric study on 528 breast cancers during the year 2005. Arch Gynecol Obstet 2009; 281:491-8. [PMID: 19554339 DOI: 10.1007/s00404-009-1163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our purpose was to assess development of sentinel lymph node biopsy (SLNB) in two Burgundy districts during the year 2005. METHODS All women undergoing breast surgery as primary care between 1 January 2005 and 1 January 2006 were eligible for inclusion. Eleven surgeons from five different breast-treatment centres took part in this prospective multicentric study. As our objective was to evaluate practices, patients were not randomized and surgeons were free to choose treatment patterns. RESULTS The 528 enrolled cases account for 90% of all new breast cancers in 2005 in Cote d'Or and Saône et Loire. Half of these patients (286) fulfilled requirements for SLNB. The others (242) had primary full axillary clearance (AC). Four of our five centres offer double-detection of sentinel lymph nodes as well as intraoperative pathology examination. Most tumours were invasive ductal carcinomas, with an average size of 12 mm in the SLNB group (T1C) and 22 mm in the AC group (T2). Two or three lymph nodes were removed during each SLNB procedure. Whereas most SLNB studies report around 25% positive nodes, we barely recorded 18.5% (53 of our 256 patients). Moreover, 2/3 of these node-positive patients had optimal care since additional axillary clearance was done right away. CONCLUSION Sentinel lymph node biopsy has become routine practice in our Burgundy area. It is mainly dedicated to early stage breast cancer with limited metastatic risk. Our surgeons follow the most recent guidelines and indications are the same regardless of treatment centre.
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Cutuli B, Lemanski C, Fourquet A, de Lafontan B, Giard S, Meunier A, Pioud-Martigny R, Campana F, Marsiglia H, Lancrenon S, Mery E, Penault-Llorca F, Fondrinier E, Tunon de Lara C. Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience. Br J Cancer 2009; 100:1048-54. [PMID: 19277037 PMCID: PMC2670007 DOI: 10.1038/sj.bjc.6604968] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
From March 2003 to April 2004, 77 physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30–84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS+RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS+RT and mastectomy, respectively, P<0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS+RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20–37%; adjuvant RT, 84–96%; hormone treatment, 6–34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.
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Affiliation(s)
- B Cutuli
- Radiation Oncology Department, Polyclinique Courlancy, Reims, France.
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Takács T, Paszt A, Szentpáli K, Ormándi K, Lázár M, Pálka I, Kahán Z, Lázár G. Importance of Sentinel Lymph Node Biopsy in Surgical Therapy of in situ Breast Cancer. Pathol Oncol Res 2008; 15:329-33. [DOI: 10.1007/s12253-008-9123-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 11/05/2008] [Indexed: 11/28/2022]
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12
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van la Parra RFD, Ernst MF, Barneveld PC, Broekman JM, Rutten MJCM, Bosscha K. The value of sentinel lymph node biopsy in ductal carcinoma in situ (DCIS) and DCIS with microinvasion of the breast. Eur J Surg Oncol 2008; 34:631-5. [PMID: 17851019 DOI: 10.1016/j.ejso.2007.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 08/06/2007] [Indexed: 11/15/2022] Open
Abstract
AIM Ductal carcinoma in situ (DCIS) refers to the preinvasive stage of breast carcinoma and should not give axillary metastases. Its diagnosis, however, is subject to sampling errors. The role of sentinel lymph node biopsy (SLNB) in management of DCIS or DCISM (with microinvasion) remains unclear. The purpose of this study was to review our experience with SLNB in DCIS and DCISM. METHODS A review of 51 patients with a diagnosis of DCIS (n=45) or DCISM (n=6), who underwent SLNB and a definitive breast operation between January 1999 and December 2006, was performed. RESULTS In 10 patients (19.6%) definitive histology revealed an invasive carcinoma. SLN (micro)metastases were detected in 5 out of 51 patients, of whom 2 had a preoperative diagnosis of grade III DCIS and 3 of DCISM. Three patients (75%) had micrometastases (< 2 mm) only. In 2 patients, histopathology demonstrated a macrometastasis (> 2 mm). All 5 patients underwent axillary dissection. No additional positive axillary lymph nodes were found. CONCLUSIONS In case of a preoperative diagnosis of grade III DCIS or a grade II DCIS with comedo necrosis and DCIS with microinvasion, an SLNB procedure has to be considered because in almost 20% of the patients an invasive carcinoma is found after surgery. In this case the SLNB procedure becomes less reliable after a lumpectomy or ablation has been performed. SLN (micro)metastases were detected in nearly 10% of the patients. The prognostic significance of individual tumour cells remains unclear.
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Affiliation(s)
- R F D van la Parra
- Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
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Le Bouëdec G, de Lapasse C, Mishellany F, Chêne G, Michy T, Gimbergues P, Dauplat J. Cancer canalaire in situ du sein avec micro-invasion. Place du ganglion sentinelle. ACTA ACUST UNITED AC 2007; 35:317-22. [PMID: 17344087 DOI: 10.1016/j.gyobfe.2006.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 12/15/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the role of sentinel lymph node biopsy for microinvasive ductal carcinoma in situ of the breast. PATIENTS AND METHODS From January 2001 to January 2006, lymphatic mapping was performed using radiocolloid and/or blue dye technique. Full axillary lymph node dissection was accomplished systematically in 10 instances at the beginning of the study, and furthermore when the sentinel node was involved (macrometastatic or micrometastatic disease). RESULTS Identification rate was 98% (40/41), the unsuccessful procedure occurred after incisional biopsy for diagnosis. The number of sentinel nodes removed was 2 in average (1-5). Sentinel node involvement was found in 10% of cases (4/40): 1 sentinel node macrometastasis pN1, 2 sentinel node micrometastases determined by hematoxylin and eosin staining pN1 (mi), 1 sentinel node micrometastasis detected only by immunohistochemical staining pN0 (mi). DISCUSSION AND CONCLUSION Sentinel lymph node sampling should not be currently applied for management of every ductal carcinoma in situ of the breast but a selective utilization is proposed in documented high risk subset of patients according to clinical, mammographic, and histologic features obtained by percutaneous biopsies. Ductal carcinoma in situ (DCIS) with proved or suspected microinvasion could be scheduled for sentinel node procedure a fortiori in cases undergoing mastectomy because of extensive DCIS before the occurrence of disturbances of lymphatic drainage induced by surgical breast dissection.
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Affiliation(s)
- G Le Bouëdec
- Service de chirurgie, centre Jean-Perrin (centre de lutte contre le cancer d'Auvergne), 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 01, France.
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Purdie CA. Sentinel lymph node biopsy: Review of the literature and guidelines for pathological handling and reporting. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2006.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cserni G, Bianchi S, Vezzosi V, Arisio R, Bori R, Peterse JL, Sapino A, Castellano I, Drijkoningen M, Kulka J, Eusebi V, Foschini MP, Bellocq JP, Marin C, Thorstenson S, Amendoeira I, Reiner-Concin A, Decker T, Lacerda M, Figueiredo P, Fejes G. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study. Pathol Oncol Res 2007; 13:5-14. [PMID: 17387383 DOI: 10.1007/bf02893435] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 01/29/2007] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node (SLN) biopsy has become the preferred method for the nodal staging of early breast cancer, but controversy exists regarding its universal use and consequences in small tumors. 2929 cases of breast carcinomas not larger than 15 mm and staged with SLN biopsy with or without axillary dissection were collected from the authors' institutions. The pathology of the SLNs included multilevel hematoxylin and eosin (HE) staining. Cytokeratin immunohistochemistry (IHC) was commonly used for cases negative with HE staining. Variables influencing SLN involvement and non-SLN involvement were studied with logistic regression. Factors that influenced SLN involvement included tumor size, multifocality, grade and age. Small tumors up to 4 mm (including in situ and microinvasive carcinomas) seem to have SLN involvement in less than 10%. Non-SLN metastases were associated with tumor grade, the ratio of involved SLNs and SLN involvement type. Isolated tumor cells were not likely to be associated with further nodal load, whereas micrometastases had some subsets with low risk of non-SLN involvement and subsets with higher proportion of further nodal spread. In situ and microinvasive carcinomas have a very low risk of SLN involvement, therefore, these tumors might not need SLN biopsy for staging, and this may be the approach used for very small invasive carcinomas. If an SLN is involved, isolated tumor cells are rarely if ever associated with non-SLN metastases, and subsets of micrometastatic SLN involvement may be approached similarly. With macrometastases the risk of non-SLN involvement increases, and further axillary treatment should be generally indicated.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, H-6000, Hungary.
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Fraile M, Gubern JM, Rull M, Julián FJ, Serra C, Llatjós M, Culell P, Puig P, Solà M, Vallejos V, Mariscal A, Janer J, Deulofeu P, Fusté F. Is it possible to refine the indication for sentinel node biopsy in high-risk ductal carcinoma in situ? Nucl Med Commun 2006; 27:785-9. [PMID: 16969260 DOI: 10.1097/01.mnm.0000230074.39071.bf] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The indication for sentinel node biopsy (SNB) has not been fully established yet for patients with ductal carcinoma in situ (DCIS). AIM To relate the conversion rate to invasive carcinoma with sentinel node positivity in high risk DCIS, and to refine the clinical presentation analysis in order to better select patients for SNB. For this purpose, a risk score was devised. METHODS From 1998 to 2005, 151 high-risk DCIS patients from six clinical centres were included in a prospective sentinel node database. The conversion rate to invasive carcinoma was 39%. Ten of 142 (7%) successful SNBs showed a positive sentinel node (eight micrometastatic). The sentinel node was positive in 1% of pure DCIS, in 5.5% of DCIS with micro-invasion, and in 19.5% of invasive carcinoma. RESULTS Both clinical presentation and corresponding risk score were closely related to conversion to invasive carcinoma. The association of risk score and sentinel node positivity approached but did not reach statistical significance (P=0.06); therefore a subset of further selected higher risk patients could not be defined. CONCLUSION The relevance of SNB positivity cannot be overlooked in high-risk DCIS patients, however, because SNB is not free from morbidity and cost, more studies are needed to refine its final indication.
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Affiliation(s)
- Manel Fraile
- Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
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