What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ?
BACKGROUND
Some surgeons have advocated sentinel node biopsy (SNB) for ductal carcinoma in situ (DCIS). The value of the information obtained is not clear.


METHODS
From 1972 to 2005, 564 selected patients with pure DCIS had axillary staging with either SNB or axillary lymph node dissection (ALND). Data were collected in a prospective database.


RESULTS
Only 2 of 564 patients had positive nodes by hematoxylin and eosin, and they were both in the ALND group. Both patients had mastectomies, were upstaged, received chemotherapy, and survived for more than 10 years without local or distant recurrence. Among 171 patients who had SNB, 10 had isolated tumor cells found by immunohistochemistry. Two patients who underwent SNB had local recurrence, neither developed distant or regional recurrence. Six of 564 patients in the ALND group developed local invasive recurrence and died of metastatic breast cancer, but none of them had positive nodes.


CONCLUSIONS
Information from lymph node examination in DCIS patients failed to predict poor outcome. SNB is useful for DCIS in mastectomy, especially with immediate reconstruction. It may be indicated for DCIS at high risk for upgrading to invasive cancer on final excision, but reliable criteria for identifying these tumors are not yet available.
Mabry
Helen
H
Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA. helenmabrymd@yahoo.com
Giuliano
Armando E
AE
Silverstein
Melvin J
MJ
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome