title: Extent of microinvasion in ductal carcinoma in situ is not associated with sentinel lymph node metastases.
abstract: BACKGROUND
  Ductal carcinoma in situ with microinvasion (DCISM) is a rare diagnosis with a good prognosis. Although nodal metastases are uncommon, sentinel lymph node biopsy (SLNB) remains standard care. Volume of disease in invasive breast cancer is associated with SLNB positivity, and, thus we hypothesized that in a large cohort of patients with DCISM, multiple foci of microinvasion might be associated with a higher risk of positive SLNB.
  
  
  METHODS
  Records from a prospective institutional database were reviewed to identify patients with DCISM who underwent SLNB between June 1997 and December 2010. Pathology reports were reviewed for number of microinvasive foci and categorized as 1 focus or ≥2 foci. Demographic, pathologic, treatment, and outcome data were obtained and analyzed.
  
  
  RESULTS
  Of 414 patients, 235 (57 %) had 1 focus of microinvasion and 179 (43 %) had ≥2 foci. SLNB macrometastases were found in 1.4 %, and micrometastases were found in 6.3 %; neither were significantly different between patients with 1 focus versus ≥2 foci (p = 1.0). Patients with positive SLNB or ≥2 foci of microinvasion were more likely to receive chemotherapy. At median 4.9 years (range 0-16.2 years) follow-up, 18 patients, all in the SLNB negative group, had recurred for an overall 5-year recurrence-free proportion of 95.9 %.
  
  
  CONCLUSIONS
  Even with large numbers, there was no higher risk of nodal involvement with ≥2 foci of microinvasion compared with 1 focus. Number of microinvasive foci and results of SLNB appear to be used in decision making for systemic therapy. Prognosis is excellent.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Cindy B
authors.initials: CB
authors.lastname: Matsen
authors.forename: Allison
authors.initials: A
authors.lastname: Hirsch
authors.forename: Anne
authors.initials: A
authors.lastname: Eaton
authors.forename: Michelle
authors.initials: M
authors.lastname: Stempel
authors.forename: Alexandra
authors.initials: A
authors.lastname: Heerdt
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Van Zee
authors.forename: Hiram S
authors.initials: HS
authors.lastname: Cody
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: George
authors.initials: G
authors.lastname: Plitas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D061206:Neoplasm Micrometastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy
references.citation: Am J Surg. 2013 Oct;206(4):478-81
references.pmid: 23791403
references.citation: Ann Surg Oncol. 2007 Aug;14(8):2202-8
references.pmid: 17534687
references.citation: Hum Pathol. 2013 Dec;44(12):2684-9
references.pmid: 24071019
references.citation: Arch Surg. 1990 Oct;125(10):1298-301; discussion 1301-2
references.pmid: 2171453
references.citation: J Oncol Pract. 2011 Sep;7(5):309-13
references.pmid: 22211128
references.citation: Eur J Radiol. 2010 Jan;73(1):102-7
references.pmid: 19026501
references.citation: J Surg Oncol. 2010 Sep 1;102(3):225-9
references.pmid: 20740579
references.citation: Ann Surg Oncol. 2013 Aug;20(8):2576-81
references.pmid: 23468047
references.citation: J Clin Oncol. 1998 Feb;16(2):441-52
references.pmid: 9469327
references.citation: J Clin Oncol. 2007 Aug 20;25(24):3670-9
references.pmid: 17664461
references.citation: Ann Surg Oncol. 2012 Oct;19(11):3416-21
references.pmid: 22576061
references.citation: Ann Surg Oncol. 2003 Dec;10(10):1160-5
references.pmid: 14654471
references.citation: Ann Oncol. 2013 Nov;24(11):2794-801
references.pmid: 23864096
references.citation: Pathol Oncol Res. 2008 Jun;14(2):105-11
references.pmid: 18493870
references.citation: J Clin Oncol. 2005 Oct 20;23(30):7497-502
references.pmid: 16234516
references.citation: Eur J Surg Oncol. 2008 Jun;34(6):631-5
references.pmid: 17851019
references.citation: Am J Surg. 2006 Jun;191(6):761-6
references.pmid: 16720145
references.citation: Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):7-13
references.pmid: 20950955
references.citation: Breast J. 2008 Jul-Aug;14(4):335-9
references.pmid: 18537917
references.citation: Lancet Oncol. 2013 Apr;14(4):297-305
references.pmid: 23491275
references.citation: Ann Surg Oncol. 2000 Oct;7(9):636-42
references.pmid: 11034239
references.citation: Breast. 2007 Apr;16(2):146-51
references.pmid: 17046258
references.citation: Am J Surg. 2007 Dec;194(6):845-8; discussion 848-9
references.pmid: 18005782
references.citation: Cancer. 2004 Jan 1;100(1):20-7
references.pmid: 14692020