A Nomogram to Predict Factors Associated with Lymph Node Metastasis in Ductal Carcinoma In Situ with Microinvasion
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Ductal carcinoma in situ (DCIS) with foci of invasion measuring ≤ 1 mm (DCISM), represents < 1% of all invasive breast cancers. Sentinel lymph node biopsy (SLNB) has been a standard component of surgery for patients with invasive carcinoma or extensive DCIS. We hypothesize that selective performance of SLNB may be appropriate given the low incidence of sentinel node (SN) metastasis for DCISM. We investigated the clinicopathologic predictors for SN positivity in DCISM, to identify which patients might benefit from SLNB.
A retrospective review of the National Cancer Database was performed for cases from 2012 to 2015. Clinical and tumor characteristics, including SN results, were evaluated, and Pearson’s Chi square tests and logistic regression were performed.
Of 7803 patients with DCISM, 306 (4%) had at least one positive SN. Patients with positive SNs were younger, more often of Black race, had higher-grade histology and larger tumor size, and were more likely to have lymphovascular invasion (LVI; all p < 0.001). In an adjusted model, the presence of LVI was associated with the highest odds ratio (OR) for node positivity (OR 8.80, 95% confidence interval 4.56–16.96).
Among women with DCISM, only 4% had a positive SN. Node positivity was associated with more extensive and higher-grade DCIS, and the presence of LVI was strongly correlated with node positivity. Our data suggest that LVI is the most important factor in determining which patients with DCISM will benefit from SN biopsy.
Jessica C. Gooch, Freya Schnabel, Jennifer Chun, Elizabeth Pirraglia, Andrea B. Troxel, Amber Guth, Richard Shapiro, Deborah Axelrod, and Daniel Roses have no disclosures to report.
- 3.Doria MT, Maesaka JY, Soares de Azevedo Neto R, de Barros N, et al. Development of a model to predict invasiveness in ductal carcinoma in situ diagnosed by percutaneous biopsy-original study and critical evaluation of the literature. Clin Breast Cancer. 2018;18(5):e805–12.Google Scholar
- 5.Pu T, Zhong X, Deng L, Li S, et al. Long term prognosis of ductal carcinoma in situ with microinvasion: a retrospective cohort study. Int J Clin Exp Pathol. 2018;11(5):2665–74.Google Scholar
- 19.Gumus H, Mills P, Fish D, Gumus M, et al. Predictive factors for invasive cancer in surgical specimens following an initial diagnosis of ductal carcinoma in situ after stereotactic vacuum-assisted breast biopsy in microcalcification-only lesions. Diagn Interv Radiol. 2016;22(1):29–34.CrossRefGoogle Scholar
- 21.Yen TW, Hunt KK, Ross MI, Mirza NQ, 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;200(4):516–26.CrossRefGoogle Scholar
- 33.Orzalesi L, Casella D, Criscenti V, Gjondedaj U, et al. Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion. Results of a large single-institution series. Breast Cancer. 2016;23(4):640–8.Google Scholar
- 42.Wang M, Wu K, Zhang P, Zhang M, et al. The prognostic significance of the oncotype DX recurrence score in T1-2N1M0 estrogen receptor-positive HER2-negative breast cancer based on the prognostic stage in the updated AJCC 8th edition. Ann Surg Oncol. 2019;26(5):1227–35.Google Scholar
- 43.Wang M, Wu K, Chen H. ASO Author reflections: oncotype DX RS complementing the prognostic stage in the updated AJCC 8th edition for T1-2N1M0 ER-positive HER2-negative breast cancer. Ann Surg Oncol. 2019;26(5):1236–7.Google Scholar