title: Is sentinel lymph node biopsy indicated in patients with a diagnosis of ductal carcinoma in situ? A systematic literature review and meta-analysis.
abstract: BACKGROUND
  Recent discussion has suggested that some cases of ductal carcinoma in situ (DCIS) with high risk of invasive disease may require sentinel lymph node biopsy (SLNB).
  
  
  METHODS
  Systematic literature review identified 48 studies (9,803 DCIS patients who underwent SLNB). Separate analyses for patients diagnosed preoperatively by core sampling and patients diagnosed postoperatively by specimen pathology were conducted to determine the percentage of patients with axillary nodal involvement. Patient factors were analyzed for associations with risk of nodal involvement.
  
  
  RESULTS
  The mean percentage of positive SLNBs was higher in the preoperative group (5.95% vs 3.02%; P = .0201). Meta-regression analysis showed a direct association with tumor size (P = .0333) and grade (P = .00839) but not median age nor tumor upstage rate.
  
  
  CONCLUSIONS
  The SLNB should be routinely considered in patients with large (>2 cm) high-grade DCIS after a careful multidisciplinary discussion. In the context of breast conserving surgery, the SLNB is not routinely indicated for low- and intermediate-grade DCIS, high-grade DCIS smaller than 2 cm, or pure DCIS diagnosed by definitive surgical excision.
authors: The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK. Electronic address: haj_shehadeh_hiba@hotmail.com.
authors: Hiba
authors: H
authors: El Hage Chehade
authors: The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
authors: Hannah
authors: H
authors: Headon
authors: The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
authors: Umar
authors: U
authors: Wazir
authors: The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
authors: Houssam
authors: H
authors: Abtar
authors: The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
authors: Abdul
authors: A
authors: Kasem
authors: The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
authors: Kefah
authors: K
authors: Mokbel
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000556:secondary*; D005260:Female; D006801:Humans; D020380:Needs Assessment; D018579:Patient Selection; D021701:Sentinel Lymph Node Biopsy
keywords: Breast cancer; Ductal carcinoma in situ; Sentinel lymph node biopsy