title: The Role of Sentinel Lymph Node Biopsy and Factors Associated with Invasion in Extensive DCIS of the Breast Treated by Mastectomy: The Cinnamome Prospective Multicenter Study.
abstract: BACKGROUND
  When invasive components are discovered at mastectomy for vacuum-assisted biopsy (VAB)-diagnosed ductal carcinoma in situ (DCIS), the only option available is axillary lymph node dissection (ALND). The primary aim of this prospective multicenter trial was to determine the benefit of performing upfront sentinel lymph node (SLN) biopsy for these patients. The secondary aim was to determine DCIS factors associated with microinvasion or invasion.
  
  
  METHODS
  The SLN procedure was performed during mastectomy, and for positive SLN an ALND was performed during the same intervention. A tissue microarray containing DCIS lesions from the mastectomy specimens was subsequently performed.
  
  
  RESULTS
  From May 2008 to December 2010, 228 patients were enrolled from 14 French cancer centers, including 192 eligible patients with pure DCIS on VAB and successful SLN procedures. ALND was avoided for 51 [67 %; 95 % confidence interval (CI), 56-77 %] of all the patients who had microinvasive DCIS or DCIS associated with invasive carcinoma at mastectomy and a negative SLN. Of the 192 patients, 76 (39 %) with VAB-diagnosed DCIS were upgraded after mastectomy to micro (n = 20) or invasive disease (n = 56). The rate of positive SLN for patients with DCIS on VAB was 14 %. High nuclear grade of DCIS was associated with greater risk of microinvasion and invasion, and HER2-amplified DCIS was associated with greater risk of invasion.
  
  
  CONCLUSIONS
  Underestimation of invasive components is high when DCIS is diagnosed by VAB in patients undergoing mastectomy. Upfront SLN for patients with VAB-diagnosed extensive DCIS avoids unnecessary ALND for two-thirds of patients with micro or invasive disease on mastectomy.
authors.affiliation: Department of Surgery, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France. c.tunondeLara@bordeaux.unicancer.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Tunon-de-Lara
authors.affiliation: Department of Surgery, Centre Oscar Lambret, Lille, France.
authors.forename: Marie Pierre
authors.initials: MP
authors.lastname: Chauvet
authors.affiliation: Department of Pathology, Centre Oscar Lambret, Lille, France.
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Baranzelli
authors.affiliation: Department of Surgery, Centre Henri Becquerel, Rouen, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Baron
authors.affiliation: Department of Pathology, Centre Henri Becquerel, Rouen, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Piquenot
authors.affiliation: Department of Surgery, Centre Jean Perrin, Clermont-Ferrand Cedex 1, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Le-Bouédec
authors.affiliation: Department of Pathology, Centre Jean Perrin, Clermont-Ferrand Cedex 1, France.
authors.forename: Fréderique
authors.initials: F
authors.lastname: Penault-Llorca
authors.affiliation: Department of Surgery, Institut Gustave Roussy, Villejuif, France.
authors.forename: Jean-Rémi
authors.initials: JR
authors.lastname: Garbay
authors.affiliation: Department of Surgery, Centre Eugène Marquis, Rennes, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Blanchot
authors.affiliation: Department of Surgery, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Mollard
authors.affiliation: Department of Pathology, Centre Claudius Regaud, Toulouse, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Maisongrosse
authors.affiliation: University of Bordeaux, Bordeaux, France.|Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.|INSERM U897, CIC-EC07, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pélissier
authors.affiliation: Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France.
authors.forename: Gaëtan
authors.initials: G
authors.lastname: MacGrogan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D021701:Sentinel Lymph Node Biopsy; D046888:Tissue Array Analysis; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human