title: Is it possible to refine the indication for sentinel node biopsy in high-risk ductal carcinoma in situ?
abstract: 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.
authors.affiliation: Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. mfraile@ns.hugtip.scs.es
authors.forename: Manel
authors.initials: M
authors.lastname: Fraile
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gubern
authors.forename: Miquel
authors.initials: M
authors.lastname: Rull
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Julián
authors.forename: Cristina
authors.initials: C
authors.lastname: Serra
authors.forename: Mariona
authors.initials: M
authors.lastname: Llatjós
authors.forename: Pere
authors.initials: P
authors.lastname: Culell
authors.forename: Pere
authors.initials: P
authors.lastname: Puig
authors.forename: Montse
authors.initials: M
authors.lastname: Solà
authors.forename: Virginia
authors.initials: V
authors.lastname: Vallejos
authors.forename: Antonio
authors.initials: A
authors.lastname: Mariscal
authors.forename: Joan
authors.initials: J
authors.lastname: Janer
authors.forename: Pere
authors.initials: P
authors.lastname: Deulofeu
authors.forename: Ferràn
authors.initials: F
authors.lastname: Fusté
mesh_terms: 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