Abstract
This article provides evidence-based guidelines for the appropriate management of the sentinel lymph node (SLN) in patients with ductal carcinoma in situ (DCIS). Invasive cancer can often be intimately associated with DCIS. With minimally invasive core biopsy techniques, 20 % of preoperatively diagnosed DCIS will be upstaged to invasive cancer on final pathology. The clinician must consider a patient’s chances of having an invasive malignancy concealed in an area of DCIS. Palpable tumor and large mammographic DCIS size > 5 cm are the most consistent predictors of underlying invasive cancer and metastasis to SLNs. DCIS with microinvasion (DCISM) parallels DCIS with respect to risk for identification of nodal metastases. However, identification of isolated tumor cells (ITCs) or micrometastases in the SLN may lead to overtreatment. When local excision is performed for DCIS, SLN biopsy is possible as a subsequent procedure if invasion is identified on final pathology. Several meta-analyses have reported SLN positivity rates for pure DCIS between 3 and 4 %. In patients with pure DCIS, lymph node status failed to predict inferior outcomes and hence should not change subsequent management. Therefore, local control should be the goal for treatment of DCIS and systemic treatment targeted to the biology of any invasive component.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Fuhrman GM. Pro: SLNB in DCIS. Ann Surg Oncol. 2007;14(3):1005–6.
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(4):516–26.
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(9):636–42.
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(4):563–6.
Cox CE, Nguyen K, Gray RJ, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg. 2001;67(6):513–9.
Yi M, Krishnamurthy S, Kuerer HM, et al. Role of primary tumor characteristics in predicting positive sentinel lymph nodes in patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2008;196(1):81–7.
Guillot E, Vaysse C, Goetgeluck J, et al. Extensive pure ductal carcinoma in situ of the breast: identification of predictors of associated infiltrating carcinoma and lymph node metastasis before immediate reconstructive surgery. Breast. 2014;23(2):97–103.
Lee SK, Yang JH, Woo SY, Lee JE, Nam SJ. Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg. 2013;100(13):1756–63.
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(10):2911–7.
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(2):315–9.
Cody HS 3rd. Sentinel lymph node biopsy for DCIS: are we approaching consensus? Ann Surg Oncol. 2007;14(8):2179–81.
Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: american society of clinical oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83.
Veronesi P, Intra M, Vento AR, et al. Sentinel lymph node biopsy for localized ductal carcinoma in situ. Breast 2005;14:520–2.
Zavagno G, Carcoforo P, Marconato R, et al. Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. BMC Cancer. 2005;5:28.
Kelly TA, Kim JA, Patrick R, et al. Axillary lymph node metastases in patients with a final diagnosis of ductal carcinoma in situ. Am J Surg. 2003;186:368–70.
Farkas EA, Stolier AJ, Teng SC, et al. An argument against routine sentinel node mapping for DCIS. Am Surg. 2004:70:876–80.
Mittendorf ME, 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.
Cserni G, Boross G, Maraz R, et al. Sentinel lymph node biopsy for in situ carcinoma of the breast. Experience at the Bacs-Kiskun County Hospital and review of the literature. Magy Seb. 2006;59:164–72.
Mabry H, Giuliano AE, Silverstein MJ. What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ. Am J Surg. 2006;192:455–7.
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.
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.
Fraile M, Gurben JM, Rull M, et al. Is it possible to refine the indication for sentinel node biopsy in high-risk ductal carcinoma in situ. Nucl Med Commun. 2006:94:380–4.
Ansari B, Ogston SA, Purdie CA, et al. Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast. Br J Surg. 2008;95(5):547–54.
van Deurzen CH, Hobbelink MG, van Hillegersberg R, et al. Is there an indication for sentinel node biopsy in patients with ductal carcinoma in situ of the breast? A review. Eur J Cancer. 2007;43(6):993–1001.
Pendas S, Dauway E, Giuliano R, Ku N, Cox CE, Reintgen DS. Sentinel node biopsy in ductal carcinoma in situ patients. Ann Surg Oncol. 2000;7(1):15–20.
Lee LA, Siverstein MJ, Chung CT, et al. Breast cancer-specific mortality after invasive local recurrence in patients with ductal carcinoma in situ of the breast. Am J Surg. 2006;192(4):416–9.
International (Ludwig) Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet. 1990;335(8705):1565–8.
Gojon H, Fawunmi D, Valachis A. Sentinel lymph node biopsy in patients with microinvasive breast cancer: a systematic review and meta-analysis. Eur J Surg Oncol. 2014;40(1):5–11.
Gray RJ, Mulheron B, Pockaj BA, et al. The optimal management of the axillae of patients with mircoinvasive breast cancer in the sentinel lymph node era. Am J Surg. 2007;194:845–8.
Sakr R, Antoine M, Barranger E, et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma. Breast J. 2008;14:55–60.
Intra M, Zurrida S, Maffini F, et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5.
Ross DS, Hoda SA. Microinvasive (T1mic) lobular carcinoma of the breast: clinicopathologic profile of 16 cases. Am J Surg Pathol. 2011;35:75–6.
Takacs T, Paszt A, Szentpali K, et al. Importance of sentinel lymph node biopsy in surgical therapy of in situ breast cancer. Pathol Oncol Res. 2009;15:329–33.
Ko BS, Lim WS, Kim HJ, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19:212–6.
Zavagno G, Belardinelli V, Marconato R, et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast. 2007;16:146–51.
Zavotsky J, Hansen N, Brennan MB, et al. Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer. 1999;85:2439–43.
Pimiento JM, Lee MC, Esposito NN, et al. Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Pract. 2011;7:309–13.
Cserni G, Bianchi S, Vezzosi V, et al. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study. Pathol Oncol Res. 2007;13:5–14.
Meretoja TJ, Heikkila PS, Salmenkivi K, et al. Outcome of patients with ductal carcinoma in situ and sentinel node biopsy. Ann Surg Oncol. 2012;19:2345–51.
Lyons 3rd JM, Stempel M, Van Zee KJ, et al. Axillary node staging for microinvasive breast cancer: is it justified? Ann Surg Oncol. 2012;19:3416–21.
Le Bouedec G, de Lapasse C, Mishellany F, et al. Ductal carcinoma in situ of the breast with microinvasion. Role of sentinel lymph node biopsy. Gynecol Obstet Fertil. 2007;35:317–22.
Guth AA, Mercado C, Roses DF, et al. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9.
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(30):7703–20.
Parikh RR, Haffty BG, Lannin D, et al. Ductal carcinoma in situ with microinvasion: prognostic implications, long-term outcomes, and role of axillary evaluation. Int J Radiat Oncol Biol Phys. 2012;82(1):7–13.
Murphy CD, Jones JL, Javid SH, et al. Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion? Am J Surg. 2008;196(4):566–8.
Cody 3rd HS, Van Zee KJ. Point: sentinel lymph node biopsy is indicated for patients with DCIS. J Natl Compr Canc Netw. 2003;1(2):199–206.
Lara JF, Young SM, Velilla RE, et al. The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. Cancer. 2003;98(10):2015–13.
Bleiweiss IJ, Nagi CS, Jaffer S. Axillary sentinel lymph nodes can be falsely positive due to iatrogenic displacement and transport of benign epithelial cells in patients with breast carcinoma. J Clin Oncol. 2006;24(13):2013–8.
Francis AM, Grimes LM, Yi M, et al. Utility of sentinel lymph node dissection (SLND) in ductal carcinoma in situ (DCIS). Abstract Society of Surgical Oncology 66th annual cancer symposium. National Harbor, Maryland, 2013.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Colfry, A., Thompson, A., Kuerer, H. (2015). DCIS and Sentinel Lymph Node Biopsy. In: Newman, L., Bensenhaver, J. (eds) Ductal Carcinoma In Situ and Microinvasive/Borderline Breast Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2035-8_12
Download citation
DOI: https://doi.org/10.1007/978-1-4939-2035-8_12
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-2034-1
Online ISBN: 978-1-4939-2035-8
eBook Packages: MedicineMedicine (R0)