title: The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes.
abstract: BACKGROUND
  Occult invasive disease could be found at definitive histology in patients initially diagnosed with large ductal carcinoma in situ (DCIS). Sentinel lymph node (SLN) biopsy is a reliable and minimally invasive procedure providing axillary information and avoiding a second operation in this particular group of patients. The aim of our study was to assess the value of SLN biopsy in patients with large DCIS who are at highest risk for being upstaged to invasive carcinoma.
  
  
  METHODS
  The study included 195 patients diagnosed with DCIS upon initial core biopsy and undergoing SLN biopsy. Many features were correlated with the presence of unsuspected invasive disease and positive SLN biopsy using univariate and multivariate analyses.
  
  
  RESULTS
  Of the 110 patients with pure DCIS, seven patients (6%) had a metastatic lymph node; 31 patients (16%) were found to have invasive disease upon final histology. Univariate analysis of predictors of unsuspected invasive carcinoma showed that patients having a preoperative biopsy that indicated DCIS with microinvasion (DCISM) or large DCIS were at a higher risk of invasive carcinoma after histological examination of the operative specimen. Of the 31 patients who were upstaged to invasive carcinoma at final histology, seven patients (22%) had a positive SLN biopsy. The analysis of predictors of positive SLN in our study shows that diffuse DCIS requiring mastectomy is the main risk factor for SLN metastasis.
  
  
  CONCLUSIONS
  There are no real predictive factors for invasive disease in patients with an initial diagnosis of DCIS or DCISM. Our study supports the value of SLN biopsy in patients with a preoperative DCISM biopsy or patients with a large pure DCIS biopsy requiring mastectomy.
authors.affiliation: AP-HP, Hôpital Tenon, Department of Gynecology, Paris Cedex, France. rita.sakr@tnn.aphp.fr
authors.forename: R
authors.initials: R
authors.lastname: Sakr
authors.forename: C
authors.initials: C
authors.lastname: Bezu
authors.forename: I
authors.initials: I
authors.lastname: Raoust
authors.forename: M
authors.initials: M
authors.lastname: Antoine
authors.forename: F
authors.initials: F
authors.lastname: Ettore
authors.forename: J
authors.initials: J
authors.lastname: Darcourt
authors.forename: K
authors.initials: K
authors.lastname: Kerrou
authors.forename: E
authors.initials: E
authors.lastname: Daraï
authors.forename: R
authors.initials: R
authors.lastname: Rouzier
authors.forename: S
authors.initials: S
authors.lastname: Uzan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology*; D044584:Carcinoma, Ductal / Q000473:pathology* / Q000556:secondary; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy