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Li X, Zhou C, Xu T, Ren Y, Li M, Shang J. Meta-analysis on axillary lymph node metastasis rate in ductal carcinoma in situ with microinvasion. Cancer Med 2024; 13:e7413. [PMID: 38925621 PMCID: PMC11199912 DOI: 10.1002/cam4.7413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/11/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To address the question of axillary lymph node staging in ductal carcinoma in situ with microinvasion (DCIS-MI), we retrospectively evaluated axillary lymph nodes metastasis (ALNM) rate in a cohort of postsurgical DCIS-MI patients. By analyzing these data, we aimed to generate clinically relevant insights to inform treatment decision-making for this patient population. METHODS A systematic search was conducted on PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang Database, Wipe, and China Biomedical Literature Database to identify relevant publications in any language. All the analyses were performed using Stata 16.0 software. RESULTS Among the 28 studies involving 8279 patients, the pooled analysis revealed an ALNM rate of 8% (95% CI, 7% to 10%) in patients with DCIS-MI. Furthermore, the rates of axillary lymph node macrometastasis, micrometastasis, and ITC in patients with DCIS-MI were 2% (95% CI, 2% to 3%), 3% (95% CI, 2% to 4%), and 2% (95% CI, 1% to 3%), respectively. Moreover, 13 studies investigated the non-sentinel lymph node (Non-SLN) metastasis rate, encompassing a total of 1236 DCIS-MI cases. The pooled analysis identified a Non-SLN metastasis rate of 33% (95% CI, 14% to 55%) in patients with DCIS-MI. CONCLUSION The SLNB for patients with DCIS-MI is justifiable and could provide a novel therapeutic basis for systemic treatment decisions.
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Affiliation(s)
- Xiongxiong Li
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
| | - Can Zhou
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ting Xu
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
| | - Yu Ren
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Meng Li
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
| | - Jin Shang
- Department of Breast SurgeryXi'an People's Hospital (Xi'an No. 4 Hospital)Xi'anChina
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Pang J, Yan Z, Tan QT, Allen JC, Wang M, Lim GH. Feasibility of Omitting Sentinel Lymph Node Biopsy in an Under-screened Cohort of Breast Cancer Patients With a Premastectomy Diagnosis of Ductal Carcinoma In Situ. Clin Breast Cancer 2024; 24:363-367. [PMID: 38458843 DOI: 10.1016/j.clbc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Nodal involvement in ductal carcinoma in situ (DCIS) is rare. In patients with DCIS diagnosis prior to mastectomy, a sentinel lymph node biopsy (SLNB) is usually performed during mastectomy, to avoid the risk of reoperation and the non-identification of SLN subsequently, should there be an upgrade to invasive cancer. We aimed to study the feasibility of omitting SLNB in an under-screened cohort, with mostly symptomatic patients and DCIS diagnosis before mastectomy, by determining the upgrade rate to invasive cancer/ DCIS microinvasion (DCISM) and its associated risk factors. METHODS Patients with pure DCIS diagnosis premastectomy were reviewed retrospectively. Patients with known DCISM or invasive cancer before mastectomy and bilateral cancers were excluded. Patients' demographics, radiological and pathological data premastectomy were analyzed. RESULTS A total of 189 patients were included. The mean age was 53.8 (range: 29-85) years old. About 64.4% presented with symptoms. 36.0% and 15.3% upgraded to invasive cancer and DCISM on mastectomy respectively. Palpable tumor (P = .0036), large size on ultrasound (P = .0283), tumor seen on mammogram and ultrasound (P = .0082), ultrasound-guided biopsy (P < .0001), high-grade DCIS on biopsy (P = .0350) and no open biopsy/lumpectomy before mastectomy (P < .0001) were associated with the upgrade, with the latter factor remaining significant after multivariable analysis. Nodal involvement was 8.47% and was associated with invasive cancer (P < .0001). CONCLUSION In a cohort who had DCIS diagnosis before mastectomy and were mostly symptomatic, the upgrade rate was 51.3%. Despite the high upgrade rate, nodal involvement remained comparable. Risk factors could select patients for omission of upfront SLNB, with a delayed SLNB planned if needed.
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Affiliation(s)
- Jinnie Pang
- Breast Department, KK Women's and Children's Hospital, Singapore.
| | - Zhiyan Yan
- Breast Department, KK Women's and Children's Hospital, Singapore
| | - Qing Ting Tan
- Breast Department, KK Women's and Children's Hospital, Singapore
| | | | | | - Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
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Lai HW, Chang YL, Chen ST, Chang YJ, Wu WP, Chen DR, Kuo SJ, Liao CY, Wu HK. Revisit the practice of lymph node biopsy in patients diagnosed as ductal carcinoma in situ before operation: a retrospective analysis of 682 cases and evaluation of the role of breast MRI. World J Surg Oncol 2021; 19:263. [PMID: 34470633 PMCID: PMC8411510 DOI: 10.1186/s12957-021-02336-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients was evaluated. Methods Patients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast MRI for ALN evaluation, predictors of breast and ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed. Results A total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients who received breast conserving surgery and 40.7% for mastectomy (p < 0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node-negative breast cancer patients with MRI tumor size < 3 cm, the NPV was 96.4%, and all these false-negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size < 3 cm and node negative suitable for BCS could safely omit SLNB if whole breast radiotherapy is to be performed. Conclusion Breast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Minimal Invasive Surgery Research Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Tumor Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Biomedical Imaging and Radiological Sciences, Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Chang Gung University College of Medicine, Taoyuan City, Taiwan. .,Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Yi-Lin Chang
- Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Yu-Jun Chang
- Center for Research and Epidemiology, Big Data Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Wen-Pei Wu
- Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Dar-Ren Chen
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shou-Jen Kuo
- Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Chiung-Ying Liao
- Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
| | - Hwa-Koon Wu
- Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan
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