Is Sentinel Lymph Node Biopsy Necessary for Ductal Carcinoma In Situ Patients Undergoing Mastectomy?
BACKGROUND
Current treatment guidelines for ductal carcinoma in situ (DCIS) treated with mastectomy recommend sentinel lymph node biopsy (SLNB). In the modern era, there is a trend toward minimizing invasive staging and treatment of the axilla. In this study, we seek to determine the role of SLNB in patients undergoing mastectomy for the treatment of DCIS.


METHODS
Patients undergoing mastectomy were identified from our institution's SLNB database from 2012 to 2016. Patients were included if core needle biopsy demonstrated DCIS. Patient demographics, tumor characteristics, and pathologic variables were abstracted.


RESULTS
Of 187 patients undergoing mastectomy with SLNB from 2012 to 2016 for DCIS or invasive ductal carcinoma, 39 (21%) were diagnosed with DCIS on core biopsy. Mean age was 57 years. 70% were Caucasian, 18% were African American, 8% were Asian, and the remaining 5% were unknown. One patient (3%) had positive nodes on SLNB and underwent axillary lymph node dissection. Of those with DCIS on core biopsy, 14 (36%) were upstaged to invasive disease on final surgical pathology, including the patient with positive SLNB. Of the remaining 25 (64%) patients with DCIS on final pathology, 0 (0%) had SLNB positivity.


CONCLUSION
Only 3% of patients with DCIS undergoing mastectomy were found to have SLN metastases. However, a significant number of patients (36%) were upstaged due to invasive cancer. Although limited by a small sample size, our results suggest that SLNB should still be recommended to patients undergoing mastectomy for DCIS on core needle biopsy due to the high rate of upstage rate to invasive disease.
['Miller-Ocuin|Jennifer L|JL|', 'Howard-McNatt|Marissa|M|', 'Levine|Edward A|EA|', 'Chiba|Akiko|A|']
D000328:Adult D000368:Aged D001365:Axilla D062005:Biopsy, Large-Core Needle D001943:Breast Neoplasms D018270:Carcinoma, Ductal, Breast D002285:Carcinoma, Intraductal, Noninfiltrating D005260:Female D006801:Humans D008207:Lymphatic Metastasis D008408:Mastectomy D008875:Middle Aged D012189:Retrospective Studies D021701:Sentinel Lymph Node Biopsy D019564:Unnecessary Procedures
sentinel lymph node biopsy ductal carcinoma in situ breast cancer