title: Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast.
abstract: BACKGROUND
  Sentinel lymph node (SLN) biopsy is an effective tool for axillary staging in patients with invasive breast cancer. This procedure has been recently proposed as part of the treatment for patients with ductal carcinoma in situ (DCIS), because cases of undetected invasive foci and nodal metastases occasionally occur. However, the indications for SLN biopsy in DCIS patients are controversial. The aim of the present study was therefore to assess the incidence of SLN metastases in a series of patients with a diagnosis of pure DCIS.
  
  
  METHODS
  A retrospective evaluation was made of a series of 102 patients who underwent SLN biopsy, and had a final histologic diagnosis of pure DCIS. Patients with microinvasion were excluded from the analysis. The patients were operated on in five Institutions between 1999 and 2004. Subdermal or subareolar injection of 30-50 MBq of 99 m-Tc colloidal albumin was used for SLN identification. All sentinel nodes were evaluated with serial sectioning, haematoxylin and eosin staining, and immunohistochemical analysis for cytocheratin.
  
  
  RESULTS
  Only one patient (0.98%) was SLN positive. The primary tumour was a small micropapillary intermediate-grade DCIS and the SLN harboured a micrometastasis. At pathologic revision of the specimen, no detectable focus of microinvasion was found.
  
  
  CONCLUSIONS
  Our findings indicate that SLN metastases in pure DCIS are a very rare occurrence. SLN biopsy should not therefore be routinely performed in patients who undergo resection for DCIS. SLN mapping can be performed, as a second operation, in cases in which an invasive component is identified in the specimen. Only DCIS patients who require a mastectomy should have SLN biopsy performed at the time of breast operation, since in these cases subsequent node mapping is not feasible.
authors.affiliation: Clinica Chirurgica II, University of Padova, Via Giustiniani 2, 35128 Padova, Italy. giorgio.zavagno@unipd.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zavagno
authors.forename: Paolo
authors.initials: P
authors.lastname: Carcoforo
authors.forename: Renato
authors.initials: R
authors.lastname: Marconato
authors.forename: Zeno
authors.initials: Z
authors.lastname: Franchini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Scalco
authors.forename: Paolo
authors.initials: P
authors.lastname: Burelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Pietrarota
authors.forename: Mario
authors.initials: M
authors.lastname: Lise
authors.forename: Roberto
authors.initials: R
authors.lastname: Mencarelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capitanio
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballarin
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Pierobon
authors.forename: Giorgia
authors.initials: G
authors.lastname: Marconato
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D044584:Carcinoma, Ductal / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy