Annals of Surgical Oncology

, Volume 20, Issue 1, pp 24–30 | Cite as

Utilization of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Undergoing Mastectomy

  • Dhruvil R. Shah
  • Robert J. Canter
  • Vijay P. Khatri
  • Richard J. Bold
  • Anthony D. Yang
  • Steve R. Martinez
Healthcare Policy and Outcomes



Current guidelines suggest consideration of sentinel lymph node biopsy (SLNB) for patients with ductal carcinoma in situ (DCIS) undergoing mastectomy. Our objective was to identify factors influencing the utilization of SLNB in this population.


We used the Surveillance Epidemiology and End Results database to identify all women with breast DCIS treated with mastectomy from 2000 to 2008. We excluded patients without histologic confirmation, those diagnosed at autopsy, those who had axillary lymph node dissections performed without a preceding SLNB, and those for whom the status of SLNB was unknown. We used multivariate logistic regression reporting odds ratios (OR) and 95 % confidence intervals (CI) to evaluate the relationship of patient- and tumor-related factors to the likelihood of undergoing SLNB.


Of 20,177 patients, 51 % did not receive SLNB. Factors associated with a decreased likelihood of receiving a SLNB included advancing age (OR 0.66; 95 % CI 0.62–0.71), Asian (OR 0.75; CI 0.68–0.83) or Hispanic (OR 0.84; 95 % CI 0.74–0.96) race/ethnicity, and history of prior non-breast (OR 0.57; 95 % CI 0.53–0.61). Factors associated with an increased likelihood of receiving a SLNB included treatment in the east (OR 1.28; 95 % CI 1.17–1.4), intermediate (OR 1.25; 95 % CI 1.11–1.41), high (OR 1.84; 95 % CI 1.62–2.08) grade tumors, treatment after the year 2000, and DCIS size 2–5 cm (OR 1.54; 95 % CI 1.42–1.68) and >5 cm (OR 2.43; 95 % CI 2.16–2.75).


SLNB is increasingly utilized in patients undergoing mastectomy for DCIS, but disparities in usage remain. Efforts at improving rates of SLNB in this population are warranted.


Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection Logistic Regression Reporting Odds Ratio Regression Reporting Odds Ratio 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Supported by Grant Number UL1 RR024146 from the National Center for Research Resources (NCRR) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NNCRR or NIH. Information on NCRR is available at Information on Re-engineering the Clinical Research Enterprise can be obtained from

Supplementary material

10434_2012_2539_MOESM1_ESM.pdf (29 kb)
Supplementary material 1 (PDF 631 kb)


  1. 1.
    Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102:170–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998-2007. Ann Surg Oncol. 2010;17:2554–62.PubMedCrossRefGoogle Scholar
  3. 3.
    McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16:2682–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Mittendorf EA, Arciero CA, Gutchell V, et al. Core biopsy diagnosis of ductal carcinoma in situ: an indication for sentinel lymph node biopsy. Curr Surg. 2005;62:253–7.PubMedCrossRefGoogle Scholar
  5. 5.
    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;190:563–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Intra M, Rotmensz N, Veronesi P, 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;247:315–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Yen TW, Hunt KK, Ross MI, 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;200:516–26.PubMedCrossRefGoogle Scholar
  8. 8.
    Dillon MF, McDermott EW, Quinn CM, et al. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol. 2006;93:559–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.PubMedCrossRefGoogle Scholar
  10. 10.
    ACR-ACS-CAP-SSO Practice Guideline for the Management of Ductal Carcinoma In-Situ of the Breast. In (ed), 2006.
  11. 11.
    Sakr R, Barranger E, Antoine M, et al. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J Surg Oncol. 2006;94:426–30.PubMedCrossRefGoogle Scholar
  12. 12.
    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;191:761–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Klauber-DeMore N, Tan LK, 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;7:636–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Moore KH, Sweeney KJ, Wilson ME, et al. Outcomes for women with ductal carcinoma-in-situ and a positive sentinel node: a multi-institutional audit. Ann Surg Oncol. 2007;14:2911–7.PubMedCrossRefGoogle Scholar
  15. 15.
    El-Tamer M, Chun J, Gill M, et al. Incidence and clinical significance of lymph node metastasis detected by cytokeratin immunohistochemical staining in ductal carcinoma in situ. Ann Surg Oncol. 2005;12:254–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Newman EA, Cimmino VM, Sabel MS, et al. Lymphatic mapping and sentinel lymph node biopsy for patients with local recurrence after breast-conservation therapy. Ann Surg Oncol. 2006;13:52–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE. Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol. 2008;15:1996–2005.PubMedCrossRefGoogle Scholar
  18. 18.
    Tan JC, McCready DR, Easson AM, Leong WL. Role of sentinel lymph node biopsy in ductal carcinoma-in-situ treated by mastectomy. Ann Surg Oncol. 2007;14:638–45.PubMedCrossRefGoogle Scholar
  19. 19.
    Reeder-Hayes KE, Bainbridge J, Meyer AM, et al. Race and age disparities in receipt of sentinel lymph node biopsy for early-stage breast cancer. Breast Cancer Res Treat. 2011;128:863–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Chen AY, Halpern MT, Schrag NM, et al. Disparities and trends in sentinel lymph node biopsy among early-stage breast cancer patients (1998–2005). J Natl Cancer Inst. 2008;100:462–74.PubMedCrossRefGoogle Scholar
  21. 21.
    Halpern MT, Chen AY, Marlow NS, Ward E. Disparities in receipt of lymph node biopsy among early-stage female breast cancer patients. Ann Surg Oncol. 2009;16:562–70.PubMedCrossRefGoogle Scholar
  22. 22.
    Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96:443–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Porembka MR, Abraham RL, Sefko JA, et al. Factors associated with lymph node assessment in ductal carcinoma in situ: analysis of 1988-2002 seer data. Ann Surg Oncol. 2008;15:2709–19.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Dhruvil R. Shah
    • 1
  • Robert J. Canter
    • 1
  • Vijay P. Khatri
    • 1
  • Richard J. Bold
    • 1
  • Anthony D. Yang
    • 1
  • Steve R. Martinez
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of California DavisSacramentoUSA

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