Ductal carcinoma in situ and sentinel lymph node biopsy: upgrading and overtreatment
Annals of Breast Surgery
The ductal carcinoma in situ (DCIS) of the breast is a heterogeneous pathology, where subgroups have different behavior patterns. As an intraductal lesion, which does not cross the basement membrane, and therefore does not infiltrate, regional staging should not be necessary. In recent years, together with the increase in the number of diagnoses of DCIS, there has been an increase in the performance of the sentinel lymph node biopsy (SLNB). The recommendations by the Spanish Society of Senology
... Society of Senology and Breast Pathology (SESPM) include: large tumors, high histological grade, comedonecrosis, palpable mass and mastectomy. These findings are related to microinvasion, and therefore to a higher risk for axillary involvement. Methods: Between 2006 and 2013, 109 DCIS patients were retrospectively analyzed to evaluate the degree of compliance with the recommendations of the SESPM. Results: SLNB was the staging procedure for 105 (96.3%) women. A positive SLN was identified in 3 patients (2.8%), micrometastases in 14 (13.3%) and isolated tumor cells (ITC) in 7 cases (6.6%). Two aspects influenced the positive result: comedonecrosis and mastectomy (P<0.001); whereby tumor size >4 cm and high histological grade were at the limit of significance. Two of three patients with macrometastases received adjuvant treatment (axillary clearance or radiation therapy). The finding of isolated tumor cells and micrometastases did not modify the axillary management. Conclusions: In our series, the recommendations of the SESPM have been insufficient to determine the risk of axillary involvement in women diagnosed with DCIS.