![]() ![]() With the increased use of screening mammography, DCIS tumors are being detected at an earlier time, at a smaller size, as nonpalpable, and associated with a lower rate of nodal involvement, if any. Thus, the routine use of sentinel node biopsy (SNB) in patients with pure DCIS does not appear to be indicated because there are no survival data of any magnitude in patients treated by SNB who have an axillary recurrence. The very low recurrence rates found in these studies is less than the positive axillary metastasis rate associated with undiagnosed invasive breast cancer with DCIS present ( 6, 11– 13). A similar finding of very low axillary recurrence in the long-term follow-up of DCIS patients treated with lumpectomy and whole-breast irradiation was reported by City of Hope Cancer Center ( 10). In a review of the NSABP DCIS protocols B-17 (lumpectomy +/- whole-breast irradiation) and B-24 (lumpectomy plus whole-breast irradiation ± tamoxifen), the risk of axillary recurrence in patients was found to be less than 1% ( 9). Following Silverstein’s report, the routine use of ALND was made optional in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-17 trial, in which patients with DCIS were randomly assigned to lumpectomy with or without whole-breast radiotherapy ( 8). After a 27 -month follow-up, two patients had recurrence, and no mortality was encountered ( 2). One hundred patients who were treated with either mastectomy (n = 49) or breast-conserving surgery and radiation therapy (n = 51) and ALND all had negative axillary lymph nodes (ALN). questioned the need for routine ALND in patients with DCIS and recommended that it be abandoned. ( 7) evaluated the treatment of DCIS using Surveillance, Epidemiology, and End Results data from 1973 to 1992 and found a decrease in the proportion of patients treated with mastectomy from 71% in 1983 to 44% in 1992. However, as the trend toward breast conservation for early-stage invasive breast cancers increased, the justification for mastectomy and ALND with only 1% positive nodal rate and a 1%–2% mortality rate for noninvasive cancer became a focus of attention ( 6). Cure rates of greater than 90% and very low mortality resulted ( 4, 5). Diagnosed pathologically by open surgical biopsy, surgical treatment recommendation consisted of mastectomy and axillary lymph node dissection (ALND). Historically, noninvasive breast cancer was detected by a palpable mass on physical examination. The diagnosis of DCIS increased from 2% of all breast cancers to as high as 30% ( 1) it can be detected on screening mammography in 15%–20% of cases and accounts now for 14%–30% of all diagnosed breast cancers ( 1– 3). The 1980s brought increased public awareness of breast cancer and improved mammography equipment and techniques that resulted in more frequent diagnoses of nonpalpable occult breast carcinoma. It is considered a local disease with no regional involvement. Additionally, SLNB is advisable for DCIS cases that are palpable or show a mass effect on mammography.Noninvasive carcinoma of the breast or ductal carcinoma in situ (DCIS) is histologically defined as proliferating malignant ductal cells limited to the ducts themselves, without evidence of invasion through the basement membrane into the surrounding stroma. ![]() ![]() Nonetheless, in the event that both factors are found in the same case, SLNB may be indicated. Conclusions: The results suggest that high-grade DCIS or DCIS with a size >3 cm, independently, does not require SLNB. In addition, mass effect and palpation were independently associated with a significantly greater degree of IC (OR = 12.76 95% CI 6.93–23.52). Nevertheless, when a high grade and size (>3 cm) were combined, IC was more likely to exist (72.7 vs. When the DCIS was high grade or the size was >3 cm, there was no significant difference in the probability of finding IC in the surgical specimen (OR = 1.13 95% CI 0.84–1.51 OR = 1.2 95% CI 0.85–1.40). Results: On the whole, 468 “high-risk” DCIS cases were identified, 139 (29%) of which had IC. Methods: Data was collected from 3 different institutions between 20, recording characteristics such as, but not limited to: high grade, size >3 cm, mass effect on mammography, and palpable mass. We studied the correlation of the aforesaid factors with the probability of finding IC in the surgical specimen. However, in certain cases (size >3 cm, high grade, mass effect on mammography, or palpable mass), it may be possible to find incidental invasive carcinoma (IC) that requires an SLNB. Introduction: Sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) is not indicated. ![]()
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