Sentinel lymph node biopsy for ductal carcinoma in situ Journal Article

  


Author: Cody, H. S. 3rd
Article Title: Sentinel lymph node biopsy for ductal carcinoma in situ
Abstract: Sentinel lymph node (SLN) biopsy is a new standard of care for the staging of breast cancer and has the potential to replace routine axillary node dissection (ALND) for the majority of patients with clinical stage T1-2 NO invasive disease. Its role in ductal carcinoma in situ (DCIS) remains undefined. Because axillary metastases occur in fewer than 1% of all DCIS cases and long-term survival is about 99% regardless of local therapy, current guidelines dictate no axillary staging in this setting. Three recent case series collectively demonstrated that (1) positive SLNs are found in 6% to 13% of consecutive unselected DCIS patients and in 12% of DCIS patients believed to be at high risk of underlying invasive disease, (2) the majority of positive SLNs in DCIS are micrometastases found only on immunohistochemical (IHC) staining, and (3) the yield of completion ALND after a positive SLN biopsy is small. The strongest justification for SLN biopsy in DCIS is the inability of conventional pathologic techniques to reliably rule out invasive cancer. The consequent advantages of SLN biopsy to the DCIS patient are (1) the avoidance of reoperative ALND if invasion is unexpectedly found after mastectomy and (2) the identification of hematoxylin and eosin (H&E) positive nodal metastases in a small proportion of cases, allowing systemic adjuvant treatment. Pending further study, DCIS patients with SLN micrometastases found only on IHC should not be treated conventionally as node-positive. SLN biopsy is indicated in all DCIS patients requiring mastectomy and should be considered for any DCIS patient in whom underlying invasion is suspected on the basis of either clinical or pathologic findings. © 2002 Elsevier Science (USA). All rights reserved.
Keywords: immunohistochemistry; cancer survival; conference paper; cancer adjuvant therapy; cancer staging; lymph node metastasis; sentinel lymph node biopsy; breast cancer; mastectomy; high risk patient; cancer invasion; axillary lymph node; carcinoma in situ; reoperation; technique; human; female; priority journal
Journal Title: Seminars in Breast Disease
Volume: 5
Issue: 2
ISSN: 1092-4450
Publisher: Elsevier Inc.  
Date Published: 2002-06-01
Start Page: 88
End Page: 93
Language: English
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-0036302797&partnerID=40&md5=b31ac881a871e7ae9c753f377c406963
Notes: Export Date: 14 November 2014 -- Source: Scopus