Ductal Carcinoma in Situ (DCIS) and Biopsy of the Sentinel Lymph Node
Authors:
P. Chválny; R. Donát; D. Dyttert; D. Šiška; M. Sabol; R. Králik; P. Mračna; J. Malina; J. Veselý 1; B. Duchaj 1; D. Cích 1; V. Lehotská 2; K. Rauová 2; M. Smreková 2; Š. Galbavý 3; D. Macák 3; K. Macháleková 3; T. Bokes 4
Authors‘ workplace:
Klinika onkologickej chirurgie LF UKo a OÚSA, doc. MUDr. Štefan Durdík, Ph. D.
; Klinika nukleárnej medicíny LF UKo a OÚSA, doc. MUDr. Izabela Makaiová, CSc.
1; II. rádiologická klinika LF UKo a OÚSA, doc. MUDr. Viera Lehotská, Ph. D.
2; Oddelenie patológie OÚSA, prof. MUDr. Štefan Galbavý, CSc.
3; Katedra aplikovanej matematiky a štatistiky FMFI UKo, prof. RNDr. Marek Fila, DrSc.
4
Published in:
Rozhl. Chir., 2011, roč. 90, č. 6, s. 352-360.
Category:
Monothematic special - Original
Overview
Introduction:
Ductal carcinoma in situ (DCIS) is the disease with increasing incidence. Nowadays, approximately 80% DCIS are diagnosed via mammography and represent more than 20% of all types of breast cancer.
The acceptance of surgical procedures with this type of breast carcinoma is controversial as primary diagnosis of non-invasive carcinoma is often underestimated and in the end, histopathological examination reveals invasive carcinoma with biological potential to metastasize. In cases of „risk“ patient groups with DCIS, several studies report lymph node metastases.
The aim of the study has been to assess the incidence of sentinel lymph node metastatic involvement in high-risk patient group with DCIS and in ductal carcinoma in situ with microinvasion (DCISMI), to note the incidence of invasive carcinoma in definitive histopathology in patients with pre-operative diagnosis of DCIS and to analyze some predictors of invasivity.
Study type and patient group.
In retrospective analysis, we evaluated the setting of 119 patients who have been operated on at our Clinic from January, 1st 2008 until December, 31th 2010 for the diagnosis of DCIS. Prospectively, we have created the setting of 44 patients with high-risk DCIS with sentinel lymph node biopsy (SLNB) performed.
Methods and results.
Metastatic involvement of sentinel lymph node in high-risk DCIS has been found in 4 cases (9.0%) – in 1 patient (2.2%) with correct diagnosis of DCIS and in 3 patients (6.8%) with invasive carcinoma according to final histopathology. In the patient with DCIS, a micrometastasis of 0.4 mm was found in one sentinel lymph node. After complete axillary dissection, non-sentinel axillary lymph nodes metastatic involvement was not demonstrated (14/0). In 6 cases (5.0%), we identified DCISMI and did not find metastasis in sentinel lymph node.
In the high-risk DCIS group, in 4 patients (9.0%) DCISMI and in 12 patients (27.2%) invasive carcinoma was found after definitive histopathologic examination. In this group, the overall ratio of invasive lesions was 36.2%.
As for predictors of invasivity, high-grade carcinoma (OR 4,2; 95% CI 1,40-12,58) has more than 4-fold higher influence and lesion size
Key words:
DCIS – sentinel lymph node biopsy – high-risk DCIS – DCIS with microinvasion (DCISMI) – axillary dissection
Sources
1. Virnig, B. A., Tuttle, T. M., Shamliyan, T., Kane, R. L. Ductal Carcinoma In Situ of the Breast: A Systematic Review of Incidence, Treatment, and Outcomes. Journal of the National Cancer Institute, 2010; 102(3): 170–178.
2. Valenzuela, M., Julian, T. B. Ductal carcinoma in situ: biology, diagnosis and new therapies. Clin. Breast Cancer, 2007, 7: 676–681.
3. Veronesi, P., Intra, M., Vento, A. R., et al. Sentinel lymph node biopsy for localised ductal carcinoma in situ. Breast, 2005, 14: 520–522.
4. Incidencia zhubných nádorov v Slovenskej republike 2006, Národný onkologický register SR. Vydavateľstvo NCZI, Publisher NHIC, Bratislava 2010, ISBN 978-80-89292-21-9.
5. Baxter, N. N., Virnig, B. A., Dirham, S. B., et al. Trends in the treatment of ductal carcinoma in situ of the breast. J. Natl. Cancer Inst., 2004, 96: 443–448.
6. Farkas, E. A., Stolier, A. J., Teng, S. C., Bolton, J. S., Fuhrman, G. M. An argument against routine sentinel node mapping for DCIS. Am. Surg., 2004; 70: 13–18.
7. Intra, M., Rotmensz, N., Veronesi, P., Colleoni, M., et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast: the experience of the European institute of oncology on 854 patients in 10 years. Ann. Surg., 2008, Feb; 247(2): 315–319.
8. American Society of Breast Surgeons/ASBrS/ 11th Annual Meeting. Presented April 30, 2010, www.medscape.com/viewarticle/721152.
9. Klauber-DeMore, N., Tan, L. K., Liberman, L., et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann. Surg. Oncol., 2002; 7: 636–642
10. Kurniawan, E. D., Rose, A., et al. Risk Factors for Invasive Breast Cancer When Core Needle Biopsy Shows Ductal Carcinoma In Situ. Arch. Surg., 2010; 145(11).
11. Klauber-DeMore, N., Tan, L. K., Liberman, L., et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann. Surg. Oncol., 2000 Oct; 7(9): 636–642.
12. Yen, T. W., Hunt, K. K., Ross, M. I., et al. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ: a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ. J. Am. Coll. Surg., 2005 Apr; 200(4): 516–526.
13. Meijnen, P., Oldenburg, H. S., Loo, C. E., et al. Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core-needle biopsy. Br. J. Surg., 2007 Aug; 94(8): 952–926.
14. Zavagno, G., Belardinelli, V., Marconato, R., et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast, 2007 Apr; 16(2): 146–151.
15. Hilary, M. Shapiro-Wright, Julian, B. T. Sentinel Lymph Node Biopsy and Management of the Axilla in Ductal Carcinoma In Situ. Journal of the National Cancer Institute, No. 41, 2010.
16. Kelly, T. A., Kim, J. A., Patrick, R., et al. Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ. Am. J. Surg., 2003 Oct; 186(4): 368–370.
17. Mabry, H., Giuliano, A. E., Silverstein, M. J. What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ? Am. J. Surg., 2006 Oct; 192(4): 455–457.
18. Haigh, P. I., Hansen, N. M., Qi, K., et al. Biopsy method and excision volume do not affect success rate of subsequent sentinel lymph node dissection in breast cancer. Ann. Surg. Oncol., 2000 Jan-Feb; 7(1).
19. Krag, D. N., Anderson, S. J., Julian, T. B., et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol., 2007 Oct; 8(10): 881–888.
20. Huo, L., Sneige, N., Hunt, K. K., et al. Predictors of invasion in patients with core-needle biopsy-diagnosed ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy in ductal carcinoma in situ. Cancer, 2006 Oct 15; 107(8): 1760–1768.
21. Sakr, R., Barranger, E., Antoine, M., et al. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J. Surg. Oncol., 2006 Oct 1; 94(5): 426–430.
22. Intra, M., Veronesi, P., Mazzarol, G., et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch. Surg., 2003 Mar; 138(3): 309–313.
23. Liu, C. L., Yang, T. L., Chen, B. F. Sentinel lymph node mapping with emulsion of activated carbon particles in patients with pre-mastectomy diagnosis of intraductal carcinoma of the breast. J. Chin. Med. Assoc., 2003 Jul; 66(7): 406–410.
24. Zavagno, G., Belardinelli, V., Marconato, R., et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast, 2007 Apr; 16(2): 146–151.
25. Polom, K., Murawa, D., Wasiewicz, J., et al. The role of sentinel node biopsy in ductal carcinoma in situ of the breast. Eur. J. Surg. Oncol., 2009 Jan; 35(1): 43–47.
26. Van la Parra, R. F., Ernst, M. F., Barneveld, P. C., et al. The value of sentinel lymph node biopsy in ductal carcinoma in situ (DCIS) and DCIS with microinvasion of the breast. Eur. J. Surg. Oncol., 2008 Jun; 34(6): 631–635.
27. Tan, J. C., McCready, D. R., Easson, A. M., et al. Role of sentinel lymph node biopsy in ductal carcinoma-in-situ treated by mastectomy. Ann. Surg. Oncol., 2007 Feb; 14(2): 638–645.
28. Katz, A., Gage, I., Evans, S., et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am. J. Surg., 2006 Jun; 191(6): 761–766.
29. Moore, K. H., Sweeney, K. J., Wilson, M. E., et al. Outcomes for women with ductal carcinoma-in-situ and a positive sentinel node: a multi-institutional audit. Ann. Surg. Oncol., 2007 Oct; 14(10): 2911–2917.
30. Mittendorf, E. A., Arciero, C. A., Gutchell, V., et al. Core biopsy diagnosis of ductal carcinoma in situ: an indication for sentinel lymph node biopsy. Curr. Surg., 2005 Mar-Apr; 62(2): 253–257.
31. Vrtělová, P., Coufal, O., Pavlík, T., Bažout, M., Fait, V. Viditelnost na ultrasonografii jako nejsilnější prediktor invazivity u duktálních karcinomů in situ v retrospektivní studii. Klin. Onkol., 2009; 22(6): 278–283.
32. Gatěk, J., Hnatek, L., Dudešek, B. et al. Biopsie sentinelové uzliny u karcinomu prsu v klinické praxi. Rozhl. Chir., 2008; 87(4): 180–185.
33. Gatěk, J. Současný pohled na chirurgickou léčbu DCIS. Onkologie, 2010; 4(6): 353–356.
34. Fait V. Sentinelová biopsie a možnosti využití v současné onkochirurgii. Klin. Onkol., 2008; 21(1).
35. Coufal, O., Fait, V., Foltinová, V., et al. Chirurgická léčba karcinomu prsu v MOU. Rozhl. Chir., 2007; 86(10): 540–547.
36. Wilkie, C., White, L., Dupont, E., et al. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am. J. Surg., 2005, 190: 563–566.
37. Červinka, V., Šťastný, K., Nechvátal, L., Pellant, A., Ryška, A. Význam imunohistochemického vyšetření při detekci metastáz v sentinelových uzlinách karcinómu prsu. Onkologia (Bratisl.), 2008, roč. 3 (4): 268–269.
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