Is it possible to refine the indication for sentinel node biopsy in high-risk ductal carcinoma in situ?
BACKGROUND
The indication for sentinel node biopsy (SNB) has not been fully established yet for patients with ductal carcinoma in situ (DCIS).


OBJECTIVE
To relate the conversion rate to invasive carcinoma with sentinel node positivity in high risk DCIS, and to refine the clinical presentation analysis in order to better select patients for SNB. For this purpose, a risk score was devised.


METHODS
From 1998 to 2005, 151 high-risk DCIS patients from six clinical centres were included in a prospective sentinel node database. The conversion rate to invasive carcinoma was 39%. Ten of 142 (7%) successful SNBs showed a positive sentinel node (eight micrometastatic). The sentinel node was positive in 1% of pure DCIS, in 5.5% of DCIS with micro-invasion, and in 19.5% of invasive carcinoma.


RESULTS
Both clinical presentation and corresponding risk score were closely related to conversion to invasive carcinoma. The association of risk score and sentinel node positivity approached but did not reach statistical significance (P=0.06); therefore a subset of further selected higher risk patients could not be defined.


CONCLUSIONS
The relevance of SNB positivity cannot be overlooked in high-risk DCIS patients, however, because SNB is not free from morbidity and cost, more studies are needed to refine its final indication.
Fraile
Manel
M
Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. mfraile@ns.hugtip.scs.es
Gubern
Josep M
JM
Rull
Miquel
M
Julián
Francisco J
FJ
Serra
Cristina
C
Llatjós
Mariona
M
Culell
Pere
P
Puig
Pere
P
Solà
Montse
M
Vallejos
Virginia
V
Mariscal
Antonio
A
Janer
Joan
J
Deulofeu
Pere
P
Fusté
Ferràn
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis / Q000209:etiology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D012306:Risk; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data