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  11. Selective Omission Of Sentinel Lymph Node Biopsy In Mastectomy For Ductal Carcinoma In Situ: Identifying Eligible Candidates

Selective omission of sentinel lymph node biopsy in mastectomy for ductal carcinoma in situ: identifying eligible candidates

Soong June Bae1,2, Yoonwon Kook1,2, Ji Soo Jang1,2

  • 1Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Breast Cancer Research : BCR
|April 12, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

Sentinel lymph node biopsy (SLNB) may be safely omitted for select ductal carcinoma in situ (DCIS) patients undergoing mastectomy. Axillary lymph node metastasis is rare in patients over 50 or with no suspicious lymph nodes.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Sentinel lymph node biopsy (SLNB) is standard for ductal carcinoma in situ (DCIS) patients undergoing mastectomy.
  • Concerns exist regarding potential overtreatment and technical challenges of post-mastectomy SLNB.
  • Limited data exists on upstaging and axillary lymph node metastasis in DCIS patients undergoing mastectomy.

Purpose of the Study:

  • To evaluate the feasibility of omitting SLNB in patients with DCIS undergoing mastectomy.
  • To determine the rates of invasive carcinoma upgrade and axillary lymph node metastasis.
  • To identify clinicopathologic factors associated with upstaging and metastasis.

Main Methods:

  • Retrospective review of 385 DCIS patients undergoing mastectomy with SLNB or axillary lymph node dissection (2010-2021).

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  • Assessment of DCIS to invasive carcinoma upgrade rates.
  • Binary Cox regression analysis for factors associated with upstaging and metastasis.

    • Main Results:

    • 164 patients (42.6%) had DCIS upgraded to invasive carcinoma.
    • 17 patients (4.4%) had axillary lymph node metastasis.
    • Age >50 years and/or radiologically clear axillary lymph nodes were associated with low metastasis rates (1.7-2.3%).

    Conclusions:

    • Underestimation of invasive disease in DCIS is notable.
    • Axillary lymph node metastasis is infrequent in this patient cohort.
    • Omitting SLNB may be a viable option for select patients aged over 50 and/or without suspicious axillary lymph nodes.