title: Is sentinel node biopsy necessary in conservatively treated DCIS?
abstract: BACKGROUND
  We sought to identify the risk of axillary node involvement in patients with ductal carcinoma in situ (DCIS) and to determine whether axillary node assessment is necessary in these patients. Sentinel node biopsy (SNB) is replacing standard axillary lymph node dissection (ALND) for surgical staging of invasive breast cancer. Its use in patients with DCIS versus local excision (LE), observation, and/or breast irradiation remains in question.
  
  
  METHODS
  We examined the records of 813 patients with localized DCIS and disease-negative margins after LE who were randomly assigned to no further therapy or to breast irradiation in National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-17 and 1799 patients randomized to receive placebo or tamoxifen after LE + radiotherapy in NSABP trial B-24. An ALND was performed in 253 patients in NSABP B-17 and in 162 in NSABP B-24.
  
  
  RESULTS
  We found that in NSABP trial B-17, seven patients developed ipsilateral nodal recurrence (INR). Overall INR rate was 0.83/1000 patient-years. In NSABP B-24, overall INR rate was 0.36/1000 patient-years. INR can be considered a surrogate for axillary involvement at the time of DCIS diagnosis.
  
  
  CONCLUSIONS
  INR in patients with DCIS treated conservatively is extremely rare. Our findings do not support the routine use of SNB in patients with conservatively treated, localized DCIS.
authors.affiliation: National Surgical Adjuvant Breast and Bowel Project Operations Office and Biostatistical Center, Pittsburgh, Pennsylvania, USA. tjulian@wpahs.org
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Julian
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Land
authors.forename: Virginie
authors.initials: V
authors.lastname: Fourchotte
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Haile
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Fisher
authors.forename: Eleftherios P
authors.initials: EP
authors.lastname: Mamounas
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Costantino
authors.forename: Norman
authors.initials: N
authors.lastname: Wolmark
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011878:Radiotherapy; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen