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Shaaban AM, Hilton B, Clements K, Dodwell D, Sharma N, Kirwan C, Sawyer E, Maxwell A, Wallis M, Stobart H, Mylvaganam S, Litherland J, Brace-McDonnell S, Dulson-Cox J, Kearins O, Provenzano E, Ellis IO, Pinder SE, Thompson AM. The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project. Br J Cancer 2022; 127:2125-2132. [PMID: 36224403 PMCID: PMC9726983 DOI: 10.1038/s41416-022-01983-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial. METHODS We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project. RESULTS Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005). CONCLUSIONS The higher breast cancer mortality with microinvasion indicates a more aggressive disease.
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Affiliation(s)
- Abeer M Shaaban
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK.
| | | | | | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Cliona Kirwan
- Division of Informatics, Imaging & Data Sciences. School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Elinor Sawyer
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Comprehensive Cancer Centre at Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Anthony Maxwell
- Division of Informatics, Imaging & Data Sciences. School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Matthew Wallis
- Addenbrookes Hospital, Cambridge and Cambridge Breast Unit, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | | | | | | | | | | | - Elena Provenzano
- Addenbrookes Hospital, Cambridge and Cambridge Breast Unit, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Ian O Ellis
- Nottingham University Hospitals, Nottingham, UK.,Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK
| | - Sarah E Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Comprehensive Cancer Centre at Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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Chiu CW, Chang LC, Su CM, Shih SL, Tam KW. Precise application of sentinel lymph node biopsy in patients with ductal carcinoma in situ: A systematic review and meta-analysis of real-world data. Surg Oncol 2022; 45:101880. [DOI: 10.1016/j.suronc.2022.101880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
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Li G, Zhao J, Zhang X, Ma X, Li H, Chen Y, Zhang L, Zhang X, Wu J, Wang X, Zhang Y, Xu S. Toward Exempting from Sentinel Lymph Node Biopsy in T1 Breast Cancer Patients: A Retrospective Study. Front Surg 2022; 9:890554. [PMID: 35836596 PMCID: PMC9273897 DOI: 10.3389/fsurg.2022.890554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objective Sentinel lymph node biopsy (SLNB) is used to assess the status of axillary lymph node (ALN), but it causes many adverse reactions. Considering the low rate of sentinel lymph node (SLN) metastasis in T1 breast cancer, this study aims to identify the characteristics of T1 breast cancer without SLN metastasis and to select T1 breast cancer patients who avoid SLNB through constructing a nomogram. Methods A total of 1,619 T1 breast cancer patients with SLNB in our hospital were enrolled in this study. Through univariate and multivariate logistic regression analysis, we analyzed the tumor anatomical and clinicopathological factors and constructed the Heilongjiang Medical University (HMU) nomogram. We selected the patients exempt from SLNB by using the nomogram. Results In the training cohort of 1,000 cases, the SLN metastasis rate was 23.8%. Tumor volume, swollen axillary lymph nodes, pathological types, and molecular subtypes were found to be independent predictors for SLN metastasis in multivariate regression analysis. Distance from nipple or surface and position of tumor have no effect on SLN metastasis. A regression model based on the results of the multivariate analysis was developed to predict the risk of SLN metastasis, indicating an AUC of 0.798. It showed excellent diagnostic performance (AUC = 0.773) in the validation cohort. Conclusion The HMU nomogram for predicting SLN metastasis incorporates four variables, including tumor volume, swollen axillary lymph nodes, pathological types, and molecular subtypes. The SLN metastasis rates of intraductal carcinoma and HER2 enriched are 2.05% and 6.67%. These patients could be included in trials investigating the SLNB exemption.
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Affiliation(s)
- Guozheng Li
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiyun Zhao
- School of Life Science and Technology, Computational Biology Research Center, Harbin Institute of Technology, Harbin, China
| | - Xingda Zhang
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Ma
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hui Li
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yihai Chen
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lei Zhang
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Zhang
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiale Wu
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xinheng Wang
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yan Zhang
- School of Life Science and Technology, Computational Biology Research Center, Harbin Institute of Technology, Harbin, China
- Correspondence: Shouping Xu Yan Zhang
| | - Shouping Xu
- Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
- Correspondence: Shouping Xu Yan Zhang
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Davey MG, O’Flaherty C, Cleere EF, Nohilly A, Phelan J, Ronane E, Lowery AJ, Kerin MJ. OUP accepted manuscript. BJS Open 2022; 6:6563503. [PMID: 35380620 PMCID: PMC8982203 DOI: 10.1093/bjsopen/zrac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sentinel lymph node biopsy (SLNB). Quantification of the necessity of upfront SLNB for DCIS requires investigation. The aim was to establish the likelihood of having a positive SLNB (SLNB+) for DCIS and to establish parameters predictive of SLNB+. Methods A systematic review was performed as per the PRISMA guidelines. Prospective studies only were included. Characteristics predictive of SLNB+ were expressed as dichotomous variables and pooled as odds ratios (o.r.) and associated 95 per cent confidence intervals (c.i.) using the Mantel–Haenszel method. Results Overall, 16 studies including 4388 patients were included (mean patient age 54.8 (range 24 to 92) years). Of these, 72.5 per cent of patients underwent SLNB (3156 of 4356 patients) and 4.9 per cent had SLNB+ (153 of 3153 patients). The likelihood of having SLNB+ for DCIS was less than 1 per cent (o.r. <0.01, 95 per cent c.i. 0.00 to 0.01; P < 0.001, I2 = 93 per cent). Palpable DCIS (o.r. 2.01, 95 per cent c.i. 0.64 to 6.24; P = 0.230, I2 = 0 per cent), tumour necrosis (o.r. 3.84, 95 per cent c.i. 0.85 to 17.44; P = 0.080, I2 = 83 per cent), and grade 3 DCIS (o.r. 1.34, 95 per cent c.i. 0.80 to 2.23; P = 0.270, I2 = 0 per cent) all trended towards significance in predicting SLNB+. Conclusion While aggressive clinicopathological parameters may guide SLNB for patients with DCIS, the absolute and relative risk of SLNB+ for DCIS is less than 5 per cent and 1 per cent, respectively. Well-designed randomized controlled trials are required to establish fully the necessity of SLNB for patients diagnosed with DCIS. Registration number CRD42021284194 (https://www.crd.york.ac.uk/prospero/)
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Affiliation(s)
- Matthew G. Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
- Correspondence to: Matthew G. Davey, Department of Surgery, Galway University Hospitals, Galway H91YR71, Republic of Ireland (e-mail: )
| | - Colm O’Flaherty
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Eoin F. Cleere
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife Nohilly
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - James Phelan
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Evan Ronane
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J. Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J. Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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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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Yoon GY, Choi WJ, Cha JH, Shin HJ, Chae EY, Kim HH. The role of MRI and clinicopathologic features in predicting the invasive component of biopsy-confirmed ductal carcinoma in situ. BMC Med Imaging 2020; 20:95. [PMID: 32787871 PMCID: PMC7424652 DOI: 10.1186/s12880-020-00494-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background The upgrade rate of biopsy-confirmed ductal carcinoma in situ (DCIS) to invasive carcinoma is up to 50% on final pathology. We investigated MRI and clinicopathologic predictors of the invasive components of DCIS diagnosed by preoperative biopsy and then compared MRI features between patients with DCIS, microinvasive ductal carcinoma (mIDC), and invasive ductal carcinoma (IDC) diagnosed on final pathology. Methods Two hundred and one patients with 206 biopsy-confirmed DCIS lesions were enrolled. MRI and clinicopathologic features were used to predict either mIDC or IDC via a cumulative logistic regression analysis. For the lesions detected on MRI, morphologic and kinetic analyses were performed using the Chi-square, Fisher’s exact, and Kruskal-Wallis tests. Results Of all the lesions, 112 (54.4%) were diagnosed as DCIS, 50 (24.3%) were upgraded to mIDC, and 44 (21.4%) to IDC. The detection on MRI as mass (Odds ratio (OR) = 8.84, 95% confidence interval (CI) = 1.05–74.04, P = 0.045) or non-mass enhancement (NME; OR = 11.17, 95% CI = 1.35–92.36, P = 0.025), negative progesterone receptor (PR; OR = 2.40, 95% CI = 1.29–4.44, P = 0.006), and high Ki-67 level (OR = 2.42, 95% CI = 1.30–4.50, P = 0.005) were significant independent predictors of histologic upgrade. On MRI, 87 (42.2%) lesions appeared as mass and 107 (51.9%) as NME. Irregularly shaped, not-circumscribed, heterogeneous, or rim-enhancing masses with intratumoral high signal intensity or peritumoral edema, clumped or clustered ring-enhancing NMEs, and high peak enhancement were significantly associated with histologic upgrade (P < 0.001). Conclusion MRI detection, negative PR, and high Ki-67 levels are associated with a histologic upgrade in patients with biopsy-confirmed DCIS. Suspicious MRI features are more frequent in such patients.
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Affiliation(s)
- Ga Young Yoon
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Korea.,Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Ductal Carcinoma In Situ of the Breast: Perspectives on Tumor Subtype and Treatment. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7251431. [PMID: 32596362 PMCID: PMC7275239 DOI: 10.1155/2020/7251431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/18/2020] [Indexed: 01/26/2023]
Abstract
Objective To evaluate ductal carcinoma in situ (DCIS) characteristics and the effect of different treatment strategies. Patients and Methods. Using data with known hormone receptor (HoR) and human epidermal growth factor receptor 2 (HER2) status obtained by the Surveillance, Epidemiology, and End Results (SEER) program from 2010-2014, the study was conducted to investigate tumor subtype-specific differences in various characteristics, overall survival (OS), and breast cancer-specific mortality (BCSM). Results A total of 3415 patients with DCIS were eligible. Compared with HoR+/HER- subgroup, patients with triple-negative (TN) and HoR-/HER+ were commonly higher in grade, larger in size, and tended to receive mastectomy (P < 0.05). The multivariate analysis revealed that patients with TN were more likely to have a poorer OS and show a higher breast cancer-specific mortality compared with the HoR+/HER- subgroup (P < 0.05). Multivariate analysis on the history of local treatment and surgery showed patients receiving breast-conserving surgery (BCS) plus radiotherapy (R) and BCS plus axillary lymph node dissection was likely to improve OS without affecting breast cancer-specific mortality (P < 0.05). Conclusion The results demonstrate that DCIS associated with TN subtype portends poor prognosis. Meanwhile, BCS plus R was a preferable option and resulted in survival rates better than those achieved with mastectomy, and SLNB should be considered as an appropriate assessment of axillary staging in patients with DCIS.
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Hotton J, Salleron J, Rauch P, Buhler J, Pierret M, Baumard F, Leufflen L, Marchal F. Predictive factors of axillary positive sentinel lymph node biopsy in extended ductal carcinoma in situ treated by simple mastectomy at once. J Gynecol Obstet Hum Reprod 2019; 49:101641. [PMID: 31562936 DOI: 10.1016/j.jogoh.2019.101641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/30/2019] [Accepted: 09/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of positive sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) ranged from 0 to 14%. The main hypothesis would be the presence of an invasive contingent on the final histology. The objective was to identify predictive factors of sentinel lymph node positivity in the management of extended ductal carcinoma in situ treated by simple mastectomy. METHODS This was a retrospective study carried out at the Lorraine Cancer Institute from January 2003 to December 2017. Women with DCIS on core-needle biopsy whose management consisted of simple mastectomy and SLNB procedure were included. RESULTS 188 patients were analyzed. Preoperatively, 18 patients (9.6%) had DCIS with microinvasion, while the others had pure DCIS. Eight patients (4.2%) had positive sentinel lymph node biopsy, the majority of which were single micrometastases. Predictive factor of node invasion was microinvasion on biopsy (p<0.01). Only in cases of pure DCIS, the percentage of positive SLNB was reduced to 2.9%. Invasive carcinoma was found in the majority of patients with positive axillary SLNB procedure (75%, n=6), compared to 16.7% (n=30) without SLNB involvement (p<0.01). CONCLUSIONS The low rate of positive sentinel node biopsy in pure ductal carcinoma in situ suggests that in the absence of microinvasion, the sentinel procedure would seem less appropriate. New techniques for identifying sentinel lymph node biopsy could report axillary staging after definitive histologic results.
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Affiliation(s)
- Judicael Hotton
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France.
| | - Julia Salleron
- Institut de Cancérologie de Lorraine, Biostatistics Unit, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Philippe Rauch
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Julie Buhler
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Marion Pierret
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Florian Baumard
- Institut de Cancérologie de Lorraine, Biostatistics Unit, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Lea Leufflen
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Frederic Marchal
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France; Université de Lorraine, CNRS UMR7039, CRAN, F-54000 Nancy, France
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Chen C, Huang S, Huang A, Jia Y, Wang J, Zhang Z, Mao M, Wang L, Zhou J. Risk factors for lymph node metastasis and the impact of adjuvant chemotherapy on ductal carcinoma in situ with microinvasion: a population-based study. Onco Targets Ther 2018; 11:9071-9080. [PMID: 30588019 PMCID: PMC6300372 DOI: 10.2147/ott.s186228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ductal carcinoma in situ with microinvasion (DCISM) represents ~1% of all breast cancer cases. Risk factors for lymph node (LN) metastasis and appropriate adjuvant therapy for DCISM are still widely debated. METHODS We retrieved DCISM data from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry database (1998-2013). Chi-squared tests and logistic regression models were applied to investigate the potential risks of LN metastasis. Univariate and multivariate Cox proportional hazards regressions were performed to estimate the prognostic factors of DCISM. Survival outcomes were estimated using the Kaplan-Meier method. A 1:1 propensity score matching was used to minimize potential bias. RESULTS Overall, 6,219 patients with DCISM met our inclusion criteria. Younger age and higher grade disease were identified as risk factors for LN metastasis. In the multivariable analysis, LN metastasis and chemotherapy were prognostic factors for worse overall survival and breast cancer-specific survival. Furthermore, propensity score matching and subgroup analysis showed that chemotherapy may not be effective for DCISM patients. CONCLUSION Younger patients with high-grade disease tend to have LN involved in DCISM. Adjuvant chemotherapy might not be necessary for patients with DCISM.
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Affiliation(s)
- Cong Chen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Shumin Huang
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Aihua Huang
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunlu Jia
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Ji Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Zeqin Zhang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Misha Mao
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Linbo Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Jichun Zhou
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
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Wu Q, Li J, Sun S, Zhu S, Chen C, Wu J, Liu Q, Wei W, Sun S. Breast carcinoma in situ: An observational study of tumor subtype, treatment and outcomes. Oncotarget 2018; 8:2361-2371. [PMID: 27926499 PMCID: PMC5356806 DOI: 10.18632/oncotarget.13785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background & Aims To evaluate the clinical presentation, treatment and outcome of patients with breast carcinoma in situ (BCIS) with special emphasis on the role of the tumor subtype and local treatment in these patients. Methods Using data obtained by the Surveillance, Epidemiology, and End Results (SEER) program from 2010-2013, a retrospective, population-based cohort study was conducted to investigate tumor subtype-specific differences in various characteristics, overall survival (OS) and breast cancer-specific mortality (BCSM). Results In all, 6867 patients with BCIS were eligible during the 2010-2013 study period. Compared with the hormone receptor (HoR)+/HER- subgroup, patients with triple negative (TN) breast cancer were more likely to have tumors that were higher in grade and larger in size; they were also more likely to have tumors with ductal and comedo histology and were less likely to have tumors with cribriform and papillary histology (each P < 0.05). During the follow-up period, patients with TN breast cancer had an OS of 97.0% compared with 98.6 % in the HoR+/HER- subgroup (P < 0.05). Furthermore, the BCSM rate was 1.0% for the TN group compared with 0.1% for the HoR+/HER- subgroup (P < 0.05). Multivariate analysis revealed that patients with TN MBC had a poorer OS and BCSM (P <0.05). Multivariate analysis of OS with respect to the local treatment history showed that patients who received breast-conserving surgery (BCS) combined with radiotherapy (R) were more likely to have an improved OS (P < 0.05). Moreover, the results demonstrated that patients who underwent SLNB were more likely to have a lower BCSM (P < 0.05). Conclusions The results demonstrate that BCIS appears to alter the prognosis associated with the TN subtype. Meanwhile, BCS plus R was a preferable option and resulted in survival rates that were better than those achieved with mastectomy; thus, SLNB should be considered as an appropriate assessment of axillary staging in patients with BCIS.
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Affiliation(s)
- Qi Wu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Juanjuan Li
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Si Sun
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Shan Zhu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Juan Wu
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Qian Liu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Wen Wei
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
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Sun X, Li H, Liu YB, Zhou ZB, Chen P, Zhao T, Wang CJ, Zhang ZP, Qiu PF, Wang YS. Sentinel lymph node biopsy in patients with breast ductal carcinoma in situ: Chinese experiences. Oncol Lett 2015; 10:1932-1938. [PMID: 26622778 DOI: 10.3892/ol.2015.3480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 06/11/2015] [Indexed: 12/29/2022] Open
Abstract
The axillary treatment of patients with ductal carcinoma in situ (DCIS) remains controversial. The aim of the present study was to evaluate the roles of sentinel lymph node biopsy (SLNB) in patients with breast DCIS. A database containing the data from 262 patients diagnosed with breast DCIS and 100 patients diagnosed with DCIS with microinvasion (DCISM) who received SLNB between January 2002 and July 2014 was retrospectively analyzed. Of the 262 patients with DCIS, 9 presented with SLN metastases (3 macrometastases and 6 micrometastases). Patients with large tumors diagnosed by ultrasound or with tumors of high histological grade had a higher positive rate of SLNs than those without (P=0.037 and P<0.0001, respectively). Of the 100 patients with DCISM, 11 presented with metastases. Younger patients had a higher positive rate of SLNs (P=0.028). According to the results of this study and the systematic review of recent studies, the indications of SLNB for patients with DCIS are as follows: SLNB should be performed in all DCISM patients and in those DCIS patients who received mastectomy, and could be avoided in those who received breast-conserving surgery. However, SLNB should be recommended to patients who have high risks of harboring invasive components. The risk factors include a large, palpable tumor, a mammographic mass or a high histological grade.
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Affiliation(s)
- Xiao Sun
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Hao Li
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Yan-Bing Liu
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Zheng-Bo Zhou
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Peng Chen
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Tong Zhao
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Chun-Jian Wang
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Zhao-Peng Zhang
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Peng-Fei Qiu
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
| | - Yong-Sheng Wang
- The Breast Cancer Center, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China
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Matsen CB, Hirsch A, Eaton A, Stempel M, Heerdt A, Van Zee KJ, Cody HS, Morrow M, Plitas G. Extent of microinvasion in ductal carcinoma in situ is not associated with sentinel lymph node metastases. Ann Surg Oncol 2014; 21:3330-5. [PMID: 25092160 DOI: 10.1245/s10434-014-3920-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ductal carcinoma in situ with microinvasion (DCISM) is a rare diagnosis with a good prognosis. Although nodal metastases are uncommon, sentinel lymph node biopsy (SLNB) remains standard care. Volume of disease in invasive breast cancer is associated with SLNB positivity, and, thus we hypothesized that in a large cohort of patients with DCISM, multiple foci of microinvasion might be associated with a higher risk of positive SLNB. METHODS Records from a prospective institutional database were reviewed to identify patients with DCISM who underwent SLNB between June 1997 and December 2010. Pathology reports were reviewed for number of microinvasive foci and categorized as 1 focus or ≥2 foci. Demographic, pathologic, treatment, and outcome data were obtained and analyzed. RESULTS Of 414 patients, 235 (57 %) had 1 focus of microinvasion and 179 (43 %) had ≥2 foci. SLNB macrometastases were found in 1.4 %, and micrometastases were found in 6.3 %; neither were significantly different between patients with 1 focus versus ≥2 foci (p = 1.0). Patients with positive SLNB or ≥2 foci of microinvasion were more likely to receive chemotherapy. At median 4.9 years (range 0-16.2 years) follow-up, 18 patients, all in the SLNB negative group, had recurred for an overall 5-year recurrence-free proportion of 95.9 %. CONCLUSIONS Even with large numbers, there was no higher risk of nodal involvement with ≥2 foci of microinvasion compared with 1 focus. Number of microinvasive foci and results of SLNB appear to be used in decision making for systemic therapy. Prognosis is excellent.
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Affiliation(s)
- Cindy B Matsen
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Namm JP, Mueller J, Kocherginsky M, Kulkarni S. The Utility of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Suspicious for Microinvasion on Core Biopsy. Ann Surg Oncol 2014; 22:59-65. [DOI: 10.1245/s10434-014-3943-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Indexed: 01/16/2023]
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Sentinel lymph node biopsy is not necessary in patients diagnosed with ductal carcinoma in situ of the breast by stereotactic vacuum-assisted biopsy. Breast Cancer 2014; 23:190-4. [DOI: 10.1007/s12282-014-0546-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/16/2014] [Indexed: 12/15/2022]
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Han JY, Lee JH, Kim EK, Shin S, Kang MJ, Lee KC, Nam KJ. Breast US in patients with breast cancer presenting as only microcalcifications on mammography: can US differentiate ductal carcinoma in situ from invasive cancer? J Med Ultrason (2001) 2014; 41:39-44. [PMID: 27277631 DOI: 10.1007/s10396-013-0474-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To retrospectively review sonographic findings of breast cancers presenting as only microcalcifications on mammography and to evaluate factors essential for differentiating ductal carcinoma in situ (DCIS) from invasive cancers. METHODS We retrospectively reviewed the medical records of 620 consecutive patients with confirmed breast cancer according to surgery performed between March 2008 and October 2011 at our institution. Of these, 53 lesions from 52 patients who had only microcalcifications without a mass or other associated findings on mammography were selected. Sonographic findings of microcalcification areas were analyzed and correlated with the histopathological findings. RESULTS Of the 53 lesions, 26 (49.18 %) were classified as invasive cancer and 27 (50.9 %) as DCIS. Ultrasonography (US) showed only echogenic calcifications in five (9.4 %), calcifications within hypoechoic parenchymal thickening in 14 (26.4 %), calcifications within ductal changes in three (5.7 %), and calcifications within a mass in 14 (26.4 %). Seventeen (32.1 %) lesions were not visible on US. Negative findings in US were more frequently observed for DCIS (n = 15, 55.6 %) than for invasive cancers (n = 2, 7.7 %) (p < 0.001). Masses (n = 11, 42.3 % of invasive cancer; n = 3, 11.1 % of DCIS; p = 0.01) were more frequently observed in invasive cancers than in DCIS. CONCLUSIONS US findings of breast cancers presenting as only mammographic microcalcifications were significantly different between DCIS and invasive cancers. Targeted US of microcalcifications might be helpful for predicting invasive cancers and for determining the clinical preoperative work-up, including axillary staging.
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Affiliation(s)
- Ji-Yeon Han
- Department of Radiology, Dong-A University College of Medicine, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - Jin Hwa Lee
- Department of Radiology, Dong-A University College of Medicine, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea.
- Breast Center, Dong-A University Medical Center, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea.
| | - Eun-Kyung Kim
- Department of Radiology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Suyoung Shin
- Department of Radiology, Dong-A University College of Medicine, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
- Breast Center, Dong-A University Medical Center, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - Myong Jin Kang
- Department of Radiology, Dong-A University College of Medicine, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - Keun-Cheol Lee
- Department of Plastic Surgery and Reconstructive Surgery, Dong-A University College of Medicine, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - Kyung Jin Nam
- Department of Radiology, Dong-A University College of Medicine, 1,3-ga, Dongdaesin-dong, Seo-gu, Busan, 602-715, Republic of Korea
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Hahn SY, Han BK, Ko EY, Shin JH, Hwang JY, Nam M. MR features to suggest microinvasive ductal carcinoma of the breast: can it be differentiated from pure DCIS? Acta Radiol 2013; 54:742-8. [PMID: 23588154 DOI: 10.1177/0284185113484640] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Morphologic and kinetic characteristics of breast lesions are regarded as a major criterion for their differential diagnosis in dynamic magnetic resonance imaging (MRI). However, there have not been well-reported MRI findings of microinvasive ductal carcinoma. PURPOSE To evaluate MRI characteristics of microinvasive ductal carcinoma of the breast and to compare MRI findings in patients with microinvasive ductal carcinoma and pure ductal carcinoma in situ (DCIS). MATERIAL AND METHODS Eighty-one patients with pathologically confirmed microinvasive ductal carcinomas (n = 37) or pure DCIS (n = 44) were included in this study. The MRI findings were analyzed without knowledge of the pathologic and conventional imaging findings. For all the lesions detected on MRI, morphologic and kinetic analyses were performed according to the Breast Imaging Reporting and Data System. For the non-mass lesions, the presence of clustered ring enhancement was also analyzed. Statistical analyses were performed using Student's t test, χ(2) test, and Fisher's exact test. RESULTS In total 35 cases of microinvasive ductal carcinoma and 39 cases of DCIS were detected on MRI. The most common and dominant MRI findings of microinvasive ductal carcinoma and DCIS were non-mass lesions with heterogeneous enhancement. However, the spiculated margin of the mass-type lesion (P = 0.022), the segmental distribution (P = 0.023), and clustered ring enhancement (P = 0.006) of the non-mass-type lesion, and the enhancement kinetics showing strong initial enhancement (P = 0.004) with subsequent wash-out (P = 0.001) were significantly more frequent in microinvasive ductal carcinoma than in DCIS. CONCLUSION Non-mass lesions with segmental distribution, heterogeneous enhancement, and strong initial enhancement with a wash-out curve were the dominant MRI findings of microinvasive ductal carcinoma. Compared with DCIS, microinvasive ductal carcinoma showed more suspicious imaging characteristics. For the non-mass lesions, clustered ring enhancement was also a characteristic finding of microinvasion on MRI.
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Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Ji-Young Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Meeyoung Nam
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Ballehaninna UK, Chamberlain RS. Utility of intraoperative frozen section examination of sentinel lymph nodes in ductal carcinoma in situ of the breast. Clin Breast Cancer 2013; 13:350-8. [PMID: 23791128 DOI: 10.1016/j.clbc.2013.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intraoperative frozen section (IFS) examination of sentinel lymph nodes (SLN) is useful in selecting patients with invasive breast cancer for immediate axillary lymph node dissection. However, whether IFS evaluation of the SLNs in ductal carcinoma in situ (DCIS) of the breast has any value has not been previously assessed. METHODS Clinicopathologic data from patients with DCIS who underwent resection with SLN biopsy (2004-2010) were collected to assess the sensitivity, specificity, and accuracy of IFS, and its impact on axillary management. RESULTS A total of 267 patients with DCIS underwent resection with SLN biopsy and IFS evaluation. Preoperative pathology was DCIS (n = 231), DCIS with microinvasion (n = 24), and DCIS with other lesions (n = 12). Fifty-two (19.5%) patients had invasive breast cancer on final pathology. SLN metastases were identified in 13 (4.8%) patients; however, only 4 (1.5%) were IFS positive. IFS examination was negative in 263 (98.5%) patients. Among patients with SLN metastases, the most common pattern of metastases was either micrometastasis (n = 6) or immunohistochemistry-positive individual tumor cells (n = 4), whereas 3 patients had a macrometastasis. IFS examination was falsely negative in 9 of these 13 patients for a false-negative rate of 69.3%, and a sensitivity and specificity of 31% and 100% respectively. Nine of the 13 patients underwent axillary lymph node dissection and only 1 patient had further axillary metastasis. CONCLUSIONS SLN metastases in DCIS is rare and most commonly involves SLN micrometastasis or immunohistochemistry-positive individual tumor cells. SLN IFS evaluation in DCIS has a low yield and sensitivity, and can be safely omitted to reduce operative duration and cost.
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Affiliation(s)
- Umashankar K Ballehaninna
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ; Department of Surgery, Maimonides Medical Center, Brooklyn, NY
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Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision. Breast 2012; 21:641-5. [DOI: 10.1016/j.breast.2012.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/09/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
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Park HS, Park S, Cho J, Park JM, Kim SI, Park BW. Risk predictors of underestimation and the need for sentinel node biopsy in patients diagnosed with ductal carcinoma in situ by preoperative needle biopsy. J Surg Oncol 2012; 107:388-92. [PMID: 23007901 DOI: 10.1002/jso.23273] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/06/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diagnosis of ductal carcinoma in situ (DCIS) by core needle biopsy showed a high rate of underestimation of invasiveness, and performing sentinel lymph node biopsy (SLNB) in DCIS patients was controversial. METHODS We analyzed 340 DCIS patients who were diagnosed by needle biopsies. Final pathology and clinicopathological features were reviewed. Predictors were accessed using the Chi-square test and a binary logistic regression model. RESULTS The overall DCIS underestimation rate was 42.6%. The underestimation was significantly related to the palpability, mass or calcification by ultrasonography, grade, suspicious microinvasion, and biopsy method in univariate analysis. In multivariate analysis, palpability, ultrasonographic calcification or mass, suspicious microinvasion, and core needle biopsy were independent predictors of underestimation of invasive cancer. In cases with one or no risk predictors, the underestimation rate was 14.3%, whereas, in those with five predictors, it increased to 90.9%. Among 144 invasive cancer patients who underwent axillary staging, 15.4% had node metastasis. CONCLUSIONS DCIS diagnosed by preoperative needle biopsy has a high probability of underestimation, and 15% of invasive cancer patients have node metastasis. SLNB may be justified in DCIS patients undergoing needle biopsies, and caution should be exercised in omitting SLNB in patients with one or no risk predictors.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kósa C, Garami Z, Dinya T, Fülöp B. [Predictive factors of invasion with initial diagnosis of ductal carcinoma in situ based on core biopsy]. Magy Seb 2012; 65:218-21. [PMID: 22940391 DOI: 10.1556/maseb.65.2012.4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous studies suggest that sentinel lymph node biopsy (SLNB) should not be performed in case of pure ductal carcinoma in situ (DCIS) routinely. In order to avoid a second operation for invasive cancer detected postoperatively the chance of invasion need to be determined preoperatively. The purpose of our retrospective study was to evaluate the sensitivity of core biopsy and determine the predictive value of clinical and histological factors of invasion in cases when DCIS diagnosed preoperatively. MATERIAL AND METHODS Between January 2006 and December 2011, 1311 patients were treated for breast cancer in our institute, of whom preoperative core biopsy showed DCIS in 50 cases. Wide excision or quadrantectomy was performed in 41 cases, re-excision was necessary in 6 cases for positive surgical margins and mastectomy was carried out in four patients for multicentricity. In further 9 cases extensive tumour size indicated mastectomy straight away. SLNB was carried out in 31 patients, axillary block dissection (ABD) in 8 patients, while ABD for positive sentinel nodes in another two cases. Pathology showed invasion in 17 (34,7 %) cases. RESULTS Multivariate analysis showed that tumour grade, symptomatic disease, patients' age were significant predictors of invasion. Although preoperative tumour size also showed correlation with invasiveness, this was statistically not significant. CONCLUSION Evaluation of a larger patient population might be helpful to identify women who should undergo tumour excision and SLNB as a single step operation due to increased risk of invasive disease despite the preoperative diagnosis of DCIS.
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Affiliation(s)
- Csaba Kósa
- Debreceni Egyetem Orvos- és Egészségtudományi Centrum Sebészeti Intézet 4012 Debrecen Móricz Zsigmond krt. 22.
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Lyons JM, Stempel M, Van Zee KJ, Cody HS. Axillary Node Staging for Microinvasive Breast Cancer: Is It Justified? Ann Surg Oncol 2012; 19:3416-21. [PMID: 22576061 DOI: 10.1245/s10434-012-2376-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Indexed: 11/18/2022]
MESH Headings
- Adult
- Aged
- Axilla
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Breast Neoplasms, Male/drug therapy
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/surgery
- Carcinoma in Situ/drug therapy
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Lymph Nodes/surgery
- Lymphatic Metastasis
- Male
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Micrometastasis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Retrospective Studies
- Sentinel Lymph Node Biopsy
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Affiliation(s)
- John M Lyons
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Predictors of invasive breast cancer in mammographically detected microcalcification in patients with a core biopsy diagnosis of flat epithelial atypia, atypical ductal hyperplasia or ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy. Pathol Res Pract 2012; 208:217-20. [DOI: 10.1016/j.prp.2012.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/28/2012] [Accepted: 02/06/2012] [Indexed: 11/22/2022]
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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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Tang Y, Xu F, Tao K, Qian N, Toi M. Clinical applications of sentinel lymph node biopsy in ductal carcinoma in situ of the breast: a dilemma. TOHOKU J EXP MED 2011; 224:1-5. [PMID: 21502730 DOI: 10.1620/tjem.224.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast cancer is the fifth most common cause of cancer deaths in the world, which often spreads first to the axillary lymph nodes (ALN) from the primary tumor. ALN helps clinician stage breast cancer. In addition, it is one of the key prognostic factors for patients with invasive breast cancer. The sentinel lymph node (SLN) is defined as the first regional lymph node to receive lymphatic fluid from a malignant tumor. As a result, it seems possible to assess the complete nodal status with sentinel lymph node biopsy (SLNB), which is attractive and reliable approach for identifying lymph node metastasis. Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. However, the role of SLNB in DCIS is controversial because DCIS does not cause invasion and metastasis theoretically. In this review, clinical applications of SLNB in DCIS will be discussed. The potential benefit of accurately upstaging patients with DCIS and the minimal invasiveness of SLNB justify use of SLNB in selected high-risk DCIS patients. At least DSIS with microinvasion, have DCIS of sufficient extent on mammography or MRI, or indicated invasive or microinvasive focus by final histological examination, are recommended for SLNB. Moreover, large randomized trials to evaluate the usefulness of SLNB in DCIS patients after long-term follow-up on local control and survival are required for further evaluation.
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Affiliation(s)
- Yu Tang
- Departmentof Ultrasound, PLA 302 Hospital, China
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Salhab M, Patani N, Mokbel K. Sentinel lymph node micrometastasis in human breast cancer: an update. Surg Oncol 2011; 20:e195-206. [PMID: 21788132 DOI: 10.1016/j.suronc.2011.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 06/01/2011] [Accepted: 06/29/2011] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The advent of sentinel lymph node biopsy (SLNB) and advances in histopathological and molecular analysis techniques have been associated with an increase in micrometastasis (MM) detection rate. However, the clinical significance of sentinel lymph node micrometastasis (SLN MM) continues to be a subject of much debate. In this article we review the literature concerning SLN MM, with particular emphasis on the prognostic significance of SLN MM. The controversies regarding histopathological assessment, clinical relevance and management implications are also discussed. METHODS Literature review facilitated by Medline and PubMed databases. Cross referencing of the obtained articles was used to identify other relevant studies. RESULTS Published studies have reported divergent and rather conflicting results regarding the clinical significance and implications of axillary lymph node (ALN) MM in general and SLN MM in particular. Some earlier studies demonstrated no associations, however most recent studies have found SLN MM to be an indicator of poorer prognosis and to be associated with non-SLN involvement. The use of adjuvant chemotherapy and/or hormonal manipulation therapy is associated with an improved survival in patients with SLN MM. Complete ALND may be safely omitted provided that adjuvant systemic therapy recommendations are equal to patients with node-positive disease. However, optimal management of SLN MM is yet to conclude. Furthermore, the identification of MM remains largely dependent on the analytical technique employed and the use of immunohistochemistry (IHC) increases the detection rate of SLN MM. Discrepancies in the histopathological interpretation of TNM classification of SLN tumour burden do exist. Published studies were non-randomized and have significant limitations including a small sample size, limited follow-up period, and lack of standardization and reproducibility of pathological examination of the SLN. CONCLUSION Patients with SLN MM have a poorer prognosis than those who are SLN negative. Therapeutic recommendations regarding patients with SLN MM should be taken in the context of multidisciplinary team setting and in selected cases of SLN MM, complete ALND may be safely omitted. A better reproducibility of pathological interpretation of the TNM classification is required so that future therapeutic guidelines can be applied without confusion.
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Affiliation(s)
- Mohamed Salhab
- London Breast Institute, The Princess Grace Hospital, 45 Nottingham Place, London W1U 5NY, UK
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Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, Lee YM, Son BH, Gong GY, Ahn SH. Risk Factor for Axillary Lymph Node Metastases in Microinvasive Breast Cancer. Ann Surg Oncol 2011; 19:212-6. [DOI: 10.1245/s10434-011-1812-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Indexed: 11/18/2022]
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Han JS, Molberg KH, Sarode V. Predictors of Invasion and Axillary Lymph Node Metastasis in Patients with a Core Biopsy Diagnosis of Ductal Carcinoma In Situ: An Analysis of 255 Cases. Breast J 2011; 17:223-9. [DOI: 10.1111/j.1524-4741.2011.01069.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Preoperative sentinel node identification with ultrasound using microbubbles in patients with breast cancer. AJR Am J Roentgenol 2011; 196:251-6. [PMID: 21257873 DOI: 10.2214/ajr.10.4865] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Sentinel lymph node (SLN) biopsy is the standard procedure for axillary staging in early breast cancer. Lymphatic imaging after peritumoral microbubble injection has been described in animal models. The aim of this study was to identify and localize SLNs preoperatively by contrast-enhanced sonography after intradermal injection of microbubbles in patients with breast cancer. SUBJECTS AND METHODS Eighty consecutive consenting patients with primary breast cancer were recruited. Patients received a periareolar intradermal injection of microbubble contrast agent. Breast lymphatics were visualized by sonography and followed to the axilla to identify SLNs. A guidewire was deployed to localize the SLN. The next day, patients underwent standard tumor excision and SLN biopsy. RESULTS In 71 (89%) of the 80 patients, SLNs were identified and guidewires were inserted. In these patients, operative findings using conventional radioisotope and blue dye techniques confirmed that the wired nodes were SLNs. Fourteen patients were found to have metastases in SLNs. In these patients, the SLNs were identified correctly and were localized with guidewires before surgery. CONCLUSION SLNs may be identified and localized before surgery using contrast-enhanced sonography after injection of microbubbles.
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Tuttle TM, Shamliyan T, Virnig BA, Kane RL. The impact of sentinel lymph node biopsy and magnetic resonance imaging on important outcomes among patients with ductal carcinoma in situ. J Natl Cancer Inst Monogr 2010; 2010:117-20. [PMID: 20956814 DOI: 10.1093/jncimonographs/lgq023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The objective of this systematic review was to determine the impact of sentinel lymph node (SLN) biopsy and breast magnetic resonance imaging (MRI) on important outcomes for patients with ductal carcinoma in situ. We identified no study that directly evaluated important outcomes for SLN biopsy. So, we determined the incidence of SLN metastases among patients with ductal carcinoma in situ. Using American Joint Committee on Cancer criteria, the incidence of pN1 and pN1(mic) SLN metastases were 0.9% and 1.5%, respectively. Because the incidence of SLN metastasis is very low, SLN biopsy is not likely to affect important outcomes. We identified one study that directly evaluated important outcomes after breast MRI. In this study, the use of MRI did not affect local recurrence rates after breast-conserving surgery and radiation. Although MRI may identify occult multicentric or contralateral breast cancer in some patients, it may also lead to unnecessary biopsies and overtreatment.
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Affiliation(s)
- Todd M Tuttle
- Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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Parikh RR, Haffty BG, Lannin D, Moran MS. Ductal carcinoma in situ with microinvasion: prognostic implications, long-term outcomes, and role of axillary evaluation. Int J Radiat Oncol Biol Phys 2010; 82:7-13. [PMID: 20950955 DOI: 10.1016/j.ijrobp.2010.08.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 08/07/2010] [Accepted: 08/17/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the clinical-pathologic features and long-term outcomes for women with ductal carcinoma in situ (DCIS) vs. DCIS with microinvasion (DCISM) treated with breast conservation therapy (BCT), to assess the impact of microinvasion. PATIENTS AND METHODS A total of 393 patients with DCIS/DCISM from our database were analyzed to assess differences in clinical-pathologic features and outcomes for the two cohorts. RESULTS The median follow-up was 8.94 years, and the mean age was 55.8 years for the entire group. The DCISM cohort was comprised of 72 of 393 patients (18.3%). Surgical evaluation of the axilla was performed in 58.3% (n = 42) of DCISM vs. 18.1% (n = 58) of DCIS, with only 1 of 42 DCISM (2.3%) vs. 0 of 58 DCIS with axillary metastasis. Surgical axillary evaluation was not an independent predictor of local-regional relapse (LRR), distant relapse-free survival (DRFS), or overall survival (OS) in Cox proportional hazards analysis (p > 0.05). For the DCIS vs. DCISM groups, respectively, the 10-year breast relapse-free survival was 89.0% vs. 90.7% (p = 0.36), DRFS was 98.5% vs. 97.9% (p = 0.78), and OS was 93.2% vs. 95.7% (p = 0.95). The presence of microinvasion did not correlate with LRR, age, presentation, race, family history, margin status, and use of adjuvant hormonal therapy (all p > 0.05). In univariate analysis, pathology (DCIS vs. DCISM) was not an independent predictor of LRR (hazard ratio [HR], 1.58; 95% confidence interval [CI], 0.58-4.30; p = 0.36), DRFS (HR, 0.72; 95% CI, 0.07-6.95; p = 0.77), or OS (HR, 1.03; 95% CI, 0.28-3.82; p = 0.95). CONCLUSIONS Our data imply that the natural history of DCISM closely resembles that of DCIS, with a low incidence of local-regional and distant failures. On the basis of our large dataset, the incidence of axillary metastasis in DCISM appears to be small and not appear to correlate to outcomes, and thus, microinvasion alone should not be the sole criterion for more aggressive treatment.
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Affiliation(s)
- Rahul R Parikh
- The Cancer Institute of New Jersey, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Sever A, Jones S, Cox K, Weeks J, Mills P, Jones P. Preoperative localization of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasonography in patients with breast cancer. Br J Surg 2009; 96:1295-9. [PMID: 19847869 DOI: 10.1002/bjs.6725] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is the standard procedure for axillary staging in early breast cancer. Lymphatic imaging after intraparenchymal microbubble injection has been reported in animal models. The aim of this study was to identify and localize SLNs before surgery by contrast-enhanced ultrasonography after intradermal injection of microbubbles in patients with breast cancer. METHODS Fifty-four consecutive, consenting patients with primary breast cancer were recruited. Patients received a periareolar intradermal injection of microbubble contrast agent. Breast lymphatics were visualized by ultrasonography and followed to identify putative axillary SLNs. A guidewire was deployed to localize the SLN. The next day, patients underwent standard tumour excision and SLN biopsy. RESULTS SLNs were identified and guidewires inserted in 48 patients. In these patients operative findings confirmed that the wired lymph nodes were SLNs. The sensitivity of SLN detection, compared with radioisotope and blue dye, was 89 per cent. Five patients were found to have metastases in SLNs. In these patients the SLNs were identified correctly and localized before surgery with guidewires. CONCLUSION SLNs may be identified and localized before surgery using contrast-enhanced ultrasonography after injection of microbubbles.
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Affiliation(s)
- A Sever
- Department of Radiology, Maidstone Hospital Breast Clinic, The Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
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Salem A. Sentinel lymph node biopsy in breast cancer: a comprehensive literature review. JOURNAL OF SURGICAL EDUCATION 2009; 66:267-275. [PMID: 20005499 DOI: 10.1016/j.jsurg.2009.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 06/04/2009] [Accepted: 07/21/2009] [Indexed: 05/28/2023]
Abstract
Sentinel lymph node biopsy has emerged as the new standard of care for nodal staging in early-stage breast disease. In the this review, the procedure of SLNB in breast cancer will be examined in greater detail with the aim of understanding techniques that may improve results and of identifying future research questions in this field.
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Affiliation(s)
- Ahmed Salem
- Department of Surgery, Al-Bayader Hospital, Amman, Jordan.
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Fentiman IS. Which patients with ductal carcinoma in situ will benefit from sentinel node biopsy? Int J Clin Pract 2008; 62:1638-9. [PMID: 19143849 DOI: 10.1111/j.1742-1241.2008.01882.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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