Sentinel Node Procedure Obsolete in Lumpectomy for Ductal Carcinoma In Situ
Patients with a preoperative needle-biopsy diagnosis of ductal carcinoma in situ (DCIS) may have an indication for a sentinel lymph node biopsy if invasive carcinoma is found. We investigated how often a positive sentinel node and invasive carcinoma occurred in patients with a preoperative diagnosis of DCIS and whether this influenced the adjuvant regime.Materials and Methods:
From 2005 to 2014, the records of 240 patients with needle-biopsy diagnosis of DCIS were retrospectively reviewed for postoperative pathology outcomes of the sentinel node and breast, and decisions on adjuvant treatment. Descriptive statistics and univariable and multivariable analysis were used.Results:
A total of 160 of 240 patients underwent a sentinel node biopsy. Sixteen of 85 patients undergoing lumpectomy had occult invasive cancer. One patient had a micrometastasis. In patients undergoing mastectomy, 30 of 155 patients had occult invasive cancer. One patient had a micrometastasis, and 3 had a macrometastases. Eleven patients received adjuvant treatment as a result of invasive cancer. Three patients received adjuvant treatment (radiotherapy of the axilla or axillary dissection) because of node positivity. These patients underwent a primary mastectomy.Conclusion:
A positive sentinel lymph node biopsy in patients with needle-biopsy diagnosis of ductal DCIS is rare and rarely changes adjuvant regimes. Current Dutch guidelines should be updated.Micro-Abstract:
Dutch guidelines advise sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ and associated risk factors for invasive cancer. In our study of 240 patients, SLNB was obsolete in patients undergoing a lumpectomy regardless of the presence of risk factors. A positive SLNB rarely changes the adjuvant regime in these patients. Therefore, and based on other current guidelines (American Society of Clinical Oncology and National Institute for Health and Care Excellence), the current Dutch guidelines should be updated.