Axillary node staging for microinvasive breast cancer: is it justified?

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• The role of axillary staging in ductal carcinoma in situ with microinvasion (DCISM) is debated.
• Clinical characteristics and outcomes in DCISM patients require further investigation.

Purpose of the Study:

• To evaluate the clinical characteristics and outcomes of patients with DCISM.
• To determine the role and benefit of sentinel lymph node (SLN) biopsy in DCISM staging.

Main Methods:

• Retrospective analysis of 112 DCISM patients who underwent SLN biopsy between 1996 and 2004.
• Median follow-up of 6 years, with analysis of SLN status, axillary dissection (ALND) findings, and recurrence rates.

Main Results:

• 12% of patients had positive SLN (2.7% macrometastasis, 10% micrometastasis/isolated tumor cells).
• ALND in macrometastasis cases revealed additional positive nodes in 66%; no additional nodes found in micrometastasis/ITC cases.
• No locoregional or distant recurrences were observed in patients with positive SLN, while 5 locoregional recurrences occurred in patients with negative SLN.

Conclusions:

• SLN biopsy may be justified in DCISM, primarily to identify the 2.7% of patients with SLN macrometastasis who benefit from systemic therapy.
• The benefit of SLN biopsy for DCISM patients with micrometastasis/ITCs is uncertain, and ALND is not warranted in these cases.
• Routine SLN biopsy for DCISM warrants wider reappraisal.