Is sentinel lymph node biopsy required for a core biopsy diagnosis of ductal carcinoma in situ with microinvasion? Journal Article


Authors: Flanagan, M. R.; Stempel, M.; Brogi, E.; Morrow, M.; Cody, H. S. 3rd
Article Title: Is sentinel lymph node biopsy required for a core biopsy diagnosis of ductal carcinoma in situ with microinvasion?
Abstract: Background: Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM. Methods: Overall, 369 consecutive patients (2007–2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging. Results: Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1. Conclusions: Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy. © 2019, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 26
Issue: 9
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2019-09-01
Start Page: 2738
End Page: 2746
Language: English
DOI: 10.1245/s10434-019-07475-9
PUBMED: 31147995
PROVIDER: scopus
PMCID: PMC6684408
DOI/URL:
Notes: Article -- Export Date: 30 August 2019 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Monica Morrow
    468 Morrow
  2. Hiram S Cody III
    213 Cody
  3. Michelle Moccio Stempel
    138 Stempel
  4. Edi Brogi
    328 Brogi