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Abdulla HA, Khalaf Y. De-escalation of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma In Situ. Cureus 2023; 15:e37383. [PMID: 37182081 PMCID: PMC10171883 DOI: 10.7759/cureus.37383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Current guidelines recommend that sentinel lymph node biopsy (SLNB) be performed in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, in patients for whom the location of excision may compromise future SLNB, or if there is a high suspicion or risk of upstaging to invasive cancer on final pathology. Whether axillary surgery should be performed in patients with DCIS remains controversial. Our study aimed to examine the factors associated with the upgrade of DCIS to invasive cancer on final pathology and sentinel lymph node (SLN) metastases to evaluate whether axillary surgery may be safely omitted in DCIS. Methods Patients with a diagnosis of DCIS on core biopsy who underwent surgery with axillary staging between 2016 and 2022 were identified from our pathology database and retrospectively reviewed. Patients who underwent surgical management of DCIS without axillary staging and those treated for local recurrence were excluded. Results Out of 65 patients, 35.3% of patients were upstaged to the invasive disease on final pathology. 9.23% of cases had a positive SLNB. Predictive factors associated with upstaging to invasive cancer included palpable mass on clinical examination (P = 0.013), presence of a mass on preoperative imaging (P = 0.040), and estrogen receptor status (P = 0.036). Conclusion Our results support ongoing opportunities for the de-escalation of axillary surgery in patients with DCIS. In a subset of patients undergoing surgery for DCIS, SLNB may be omitted as the risk of upstaging to invasive cancer is low. Patients with a mass on clinical examination or imaging and negative estrogen receptor (ER) lesions have a higher risk of upstaging to invasive cancer, where a sentinel lymph node biopsy should be performed.
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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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Identification of patients with ductal carcinoma in situ at high risk of postoperative upstaging: A comprehensive review and an external (un)validation of predictive models developed. Eur J Obstet Gynecol Reprod Biol 2022; 271:7-14. [DOI: 10.1016/j.ejogrb.2022.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/30/2021] [Accepted: 01/27/2022] [Indexed: 12/17/2022]
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Diaz Casas SE, Serrano Muñoz WA, Buelvas Gómez NA, Osorio Ruiz AM, Ángel Aristizábal J, Guzmán Abisaab LH, Garcia Mora M, Lehmann Mosquera C, Cervera-Bonilla S, Sanchez Pedraza R. When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center. Cureus 2021; 13:e16134. [PMID: 34354880 PMCID: PMC8327396 DOI: 10.7759/cureus.16134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Ductal carcinoma in situ (DCIS) accounts for 15% of breast cancers. Surgery is the main treatment, and the use of sentinel node biopsy (SLNB) is restricted to patients at risk of infiltration, which is estimated to be around 26%. Materials and methods Aimed at evaluating the benefit of SLNB in patients with DCIS at the Breast and Soft Tissue Functional Unit of the National Cancer Institute (INC for its initials in Spanish), a descriptive observational study of a retrospective cases series was conducted between August 1, 2013, and September 30, 2018. Results A total of 40 patients with a median age of 57 years were included in the study; 62.5% of them underwent mastectomy with SLNB, and the remaining 37.5% underwent conservative surgery with SLNB. 100% of sentinel nodes were identified, by using lymphoscintigraphy in 95%. Sentinel node was positive in four patients (10%), three of whom had infiltration in the surgical specimen reported. With a follow-up of 49 months, only one patient had a local relapse. None of the patients had axillary or distant recurrence. Conclusions SLNB in DCIS should be limited to patients with risk factors for infiltration (tumor size greater than 3 cm, comedo-type histology, and high-grade DCIS), and patients with an indication for mastectomy. Its percentage of complications is low, and a high identification percentage in surgical groups with adequate training.
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Affiliation(s)
- Sandra E Diaz Casas
- Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogotá D.C, COL
| | | | | | | | | | | | - Mauricio Garcia Mora
- Breast and Soft Tissue Surgery, Instituto Nacional de Cancerología, Bogotá D.C, COL
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Han S, Qiu F, Han Y, Xu Y, Yin J, Xing F, Bian X, He G. Clinical and imaging characteristics of breast ductal carcinoma in situ with microinvasion. J Appl Clin Med Phys 2020; 22:293-298. [PMID: 33332730 PMCID: PMC7856492 DOI: 10.1002/acm2.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background We analyzed the clinical and imaging characteristics of patients with breast ductal carcinoma in situ with microinvasion (DCISM) and breast ductal carcinoma in situ (DCIS). Methods We analyzed the records of 40 patients diagnosed with DCISM and 61 patients with DCIS who were hospitalized at Shengjing Hospital (Shenyang, China) from January 2009 to June 2016. The size, hardness, and degree of calcification of tumors were determined by mammography and ultrasonography. Results In all, 37 DCISM patients and 45 DCIS patients showed clinical palpable masses (92.5% vs 73.77%, P = 0.018). Mammography showed that the mean size of tumor was larger in DCISM patients than that of DCIS patients (3.13 ± 1.51 vs 2.68 ± 1.77, P = 0.030). Ultrasound examination revealed calcification shadows in the solid tumor mass in 17 DCISM cases and 11 DCIS patients (42.5 vs 18.03%, P = 0.007). Furthermore, estrogen receptor positivity and progesterone receptor positivity were more common in DCIS patients (32.5% vs 54.10%, P = 0.033; 22.5% vs 45.90%, P = 0.017), and the percentage of menopausal patients were higher in DCISM patients than that of DCIS patients (70.00% vs 47.54%, P = 0.026). Conclusion Clinically palpable and calcified tumor masses on sonography are more commonly encountered in DCISM lesions.
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Affiliation(s)
- Sijia Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Fang Qiu
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Ye Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yongqing Xu
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jianqiao Yin
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Fei Xing
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xiaobo Bian
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Guijin He
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
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Price A, Schnabel F, Chun J, Kaplowitz E, Goodgal J, Guth A, Axelrod D, Shapiro R, Mema E, Moy L, Darvishian F, Roses D. Sentinel lymph node positivity in patients undergoing mastectomies for ductal carcinoma in situ (DCIS). Breast J 2020; 26:931-936. [PMID: 31957944 DOI: 10.1111/tbj.13737] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/01/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022]
Abstract
Current guidelines recommend sentinel lymph node biopsy (SLNB) for patients undergoing mastectomy for a preoperative diagnosis of ductal carcinoma in situ (DCIS). We examined the factors associated with sentinel lymph node positivity for patients undergoing mastectomy for a diagnosis of DCIS on preoperative core biopsy (PCB). The Institutional Breast Cancer Database was queried for patients with PCB demonstrating pure DCIS followed by mastectomy and SLNB from 2010 to 2018. Patients were divided according to final pathology (DCIS or invasive cancer). Clinico-pathologic variables were analyzed using Pearson's chi-squared, Wilcoxon Rank-Sum and logistic regression. Of 3145 patients, 168(5%) had pure DCIS on PCB and underwent mastectomy with SLNB. On final mastectomy pathology, 120(71%) patients had DCIS with 0 positive sentinel lymph nodes (PSLNs) and 48(29%) patients had invasive carcinoma with 5(10%) cases of ≥1 PSLNs. Factors positively associated with upstaging to invasive cancer in univariate analysis included age (P = .0289), palpability (P < .0001), extent of disease on imaging (P = .0121), mass on preoperative imaging (P = .0003), multifocality (P = .0231) and multicentricity (P = .0395). In multivariate analysis, palpability (P = .0080), extent of disease on imaging (P = .0074) and mass on preoperative imaging (P = .0245) remained significant (Table 2). In a subset of patients undergoing mastectomy for DCIS with limited disease on preoperative evaluation, SLNB may be omitted as the risk of upstaging is low. However, patients who present with clinical findings of palpability, large extent of disease on imaging and mass on preoperative imaging have a meaningful risk of upstaging to invasive cancer, and SLNB remains important for management.
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Affiliation(s)
- Alison Price
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Freya Schnabel
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Jennifer Chun
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Elianna Kaplowitz
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Jenny Goodgal
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Amber Guth
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Deborah Axelrod
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Richard Shapiro
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
| | - Eralda Mema
- Department of Radiology, New York University Langone Health, New York, New York
| | - Linda Moy
- Department of Radiology, New York University Langone Health, New York, New York
| | - Farbod Darvishian
- Department of Pathology, New York University Langone Health, New York, New York
| | - Daniel Roses
- Department of Surgery, Division of Breast Surgery, New York University Langone Health, New York, New York
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Si J, Guo R, Huang N, Xiu B, Zhang Q, Chi W, Wu J. Axillary evaluation is not warranted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy. Cancer Med 2019; 8:7586-7593. [PMID: 31660702 PMCID: PMC6912045 DOI: 10.1002/cam4.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/14/2019] [Accepted: 09/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Patients diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) have a great chance of upstaging to invasive cancer. Positive axillary status can be found in these patients. This study sought to identify clinicopathological factors associated with upstaging and axillary metastasis in patients preoperatively diagnosed with DCIS by CNB. Materials and Methods This study identified 604 patients (cT1‐3N0M0) with preoperative diagnosis of pure DCIS by CNB who had undergone axillary evaluation from August 2006 to December 2015 at Fudan University Shanghai Cancer Center (FUSCC). Predictors of upstaging and axillary lymph nodes metastasis were analyzed, respectively. Results Of all 604 patients, 121 (20.03%) and 193 (31.95%) patients were upstaged to DCIS with microinvasion (DCISM) and invasive breast cancer (IBC). Positive axillary lymph nodes were identified in 41 (6.79%) patients. Predictors of upstaging included tumor size on ultrasonography (>2 cm) (OR 1.786, P = .002) and ER+HER2+ status (OR 1.874, P = .022) in multivariate analysis. Factors associated with axillary lymph nodes metastasis included tumor size on pathology (OR 2.336, P = .038) and number of lesions (OR 3.354, P = .039) in multivariate analysis. In addition, upstaging on final pathology had a significant influence on axillary lymph nodes status (P < .001). Conclusion Axillary evaluation was recommended in patients with larger tumor size (>2 cm), multifocal lesions or ER+HER2+ status. Despite of a 51.98% upstaging rate, the rate of axillary metastasis in these patients was relatively low, supporting the omission of axillary evaluation in selected patients with low risk of upstaging or axillary metastasis.
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Affiliation(s)
- Jing Si
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Naisi Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qi Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Weiru Chi
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
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Si J, Yang B, Guo R, Huang N, Quan C, Ma L, Xiu B, Cao Y, Tang Y, Shen L, Chen J, Wu J. Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy. Cancer Biol Med 2019; 16:312-318. [PMID: 31516751 PMCID: PMC6713631 DOI: 10.20892/j.issn.2095-3941.2018.0159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Patients preoperatively diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) exhibit a significant risk for upstaging on final pathology, which leads to major concerns of whether axillary staging is required at the primary operation. The present study aimed to identify clinicopathological factors associated with upstaging in patients preoperatively diagnosed with DCIS by CNB. Methods The present study enrolled 604 patients (cN0M0) with a preoperative diagnosis of pure DCIS by CNB, who underwent axillary staging between August 2006 and December 2015, at Fudan University Shanghai Cancer Center (Shanghai, China). Predictive factors of upstaging were analyzed retrospectively. Results Of the 604 patients, 20.03% (n = 121) and 31.95% (n = 193) were upstaged to DCIS with microinvasion (DCISM) and invasive breast cancer (IBC) on final pathology, respectively. Larger tumor size on ultrasonography (> 2 cm) was independently associated with upstaging [odds ratio (OR) 1.558,P = 0.014]. Additionally, patients in lower breast imaging reporting and data system (BI-RADS) categories were less likely to be upstaged (4B vs. 5: OR 0.435, P = 0.002; 4C vs. 5: OR 0.502, P = 0.001). Overall, axillary metastasis occurred in 6.79% (n = 41) of patients. Among patients with axillary metastasis, 1.38% (4/290), 3.31% (4/121) and 17.10% (33/193) were in the DCIS, DCISM, and IBC groups, respectively. Conclusions For patients initially diagnosed with DCIS by CNB, larger tumor size on ultrasonography (> 2 cm) and higher BI-RADS category were independent predictive factors of upstaging on final pathology. Thus, axillary staging in patients with smaller tumor sizes and lower BI-RADS category may be omitted, with little downstream risk for upstaging.
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Affiliation(s)
- Jing Si
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Benlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Naisi Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Chenlian Quan
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Linxiaoxi Ma
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Yun Cao
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Yue Tang
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Linxiao Shen
- Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Jiajian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai 200032, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai 200032, China
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9
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Bertozzi S, Cedolini C, Londero AP, Baita B, Giacomuzzi F, Capobianco D, Tortelli M, Uzzau A, Mariuzzi L, Risaliti A. Sentinel lymph node biopsy in patients affected by breast ductal carcinoma in situ with and without microinvasion: Retrospective observational study. Medicine (Baltimore) 2019; 98:e13831. [PMID: 30608397 PMCID: PMC6344146 DOI: 10.1097/md.0000000000013831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
With the introduction of an organized mammographic screening, the incidence of ductal carcinoma in situ (DCIS) has experienced an important increase. Our experience with sentinel lymph node biopsy (SLNB) among patients with DCIS is reviewed.We collected retrospective data on patients operated on their breasts for DCIS (pTis), DCIS with microinvasion (DCISM) (pT1mi) and invasive ductal carcinoma (IDC) sized ≤2 cm (pT1) between January 2002 and June 2016, focusing on the result of SLNB.543 DCIS, 84 DCISM, and 2111 IDC were included. In cases of DCIS and DCISM, SLNB resulted micrometastatic respectively in 1.7% and 6.0% of cases and macrometastatic respectively in 0.9% and 3.6% of cases. 5-year disease-free survival and overall survival in DCISM and IDC were similar, while significantly longer in DCIS. 5-year local recurrence rate of DCIS and DCISM were respectively 2.5% and 7.9%, and their 5-year distant recurrence rate respectively 0% and 4%. IDC, tumor grading ≥2 and lymph node (LN) macrometastasis were significant predictors for decreased overall survival. Significant predictors for distant metastases were DCISM, IDC, macroscopic nodal metastasis, and tumor grading ≥2. Predictors for the microinvasive component in DCIS were tumor multifocality/multicentricity, grading ≥2, ITCs and micrometastases.Our study suggests that despite its rarity, sentinel node metastasis may also occur in case of DCIS, which in most cases are micrometastases. Even in the absence of an evident invasive component, microinvasion should always be suspected in these cases, and their management should be the same as for IDC.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
- Department of Medical Area (DAME), University of Udine
| | - Carla Cedolini
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
| | | | - Barbara Baita
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
| | | | | | - Marta Tortelli
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
| | | | - Laura Mariuzzi
- Department of Medical Area (DAME), University of Udine
- Institute of pathology, University Hospital of Udine, Udine (UD), Italy
| | - Andrea Risaliti
- Clinic of Surgery, University Hospital of Udine
- Department of Medical Area (DAME), University of Udine
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Shin ET, Joehlin-Price AS, Agnese DM, Zynger DL. Minimal Clinical Impact of Intraoperative Examination of Sentinel Lymph Nodes in Patients With Ductal Carcinoma In Situ: An Opportunity for Improved Resource Utilization. Am J Clin Pathol 2017; 148:374-379. [PMID: 29016707 DOI: 10.1093/ajcp/aqx089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES There is little information regarding sentinel lymph node (SLN) frozen-section examination in patients with a history of ductal carcinoma in situ (DCIS). We evaluated the usage, clinical impact, and pathology resources used for SLN cryosectioning in mastectomy cases with a DCIS history. METHODS Mastectomies with SLNs submitted from 2012 to 2013 at a tertiary care center were analyzed. Medicare reimbursement was used to estimate pathology health care expenditures of intraoperative frozen sections. RESULTS There was no difference in the rate of SLN frozen-section examination or parts submitted, total blocks frozen, total blocks submitted, or total SLNs identified per case between the DCIS (n = 139) and invasive (n = 369) groups. Nine patients with DCIS had SLN metastases (three macrometastases, two micrometastases, and four isolated tumor cells), all of which were examined by frozen section. Only the macrometastases were identified by cryosectioning, which led to two synchronous axillary lymph node dissections that did not yield any additional positive nodes. A total of $19,313 was spent for pathology per DCIS patient with surgical management affected, whereas only $1,019 was spent per invasive carcinoma patient affected. CONCLUSIONS Decreasing SLN frozen-section use in patients with a history of DCIS represents an opportunity for pathology cost containment.
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Affiliation(s)
| | | | - Doreen M Agnese
- Surgical Oncology, The Ohio State University Medical Center, Columbus
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Jakub JW, Murphy BL, Gonzalez AB, Conners AL, Henrichsen TL, Maimone S, Keeney MG, McLaughlin SA, Pockaj BA, Chen B, Musonza T, Harmsen WS, Boughey JC, Hieken TJ, Habermann EB, Shah HN, Degnim AC. A Validated Nomogram to Predict Upstaging of Ductal Carcinoma in Situ to Invasive Disease. Ann Surg Oncol 2017; 24:2915-2924. [DOI: 10.1245/s10434-017-5927-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 12/20/2022]
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