![]() ![]() This in turn has led to trials investigating whether SNB can be omitted altogether in breast-conserving surgery under select conditions. Recent focus with the advent of adjuvant therapies such as radiotherapy has been in tailoring breast cancer management strategies to the individual, with the aim of maximizing the benefits and avoiding unnecessary risks. In known invasive breast cancer, there is a shift towards minimizing invasive dissection in the axilla in clinically node-negative patients with one to two sentinel node metastases with seemingly no adverse effect on mortality. SNB is carried out by a radioisotope +/- blue dye subcutaneous injection into the breast, in order to trace the lymphatic channels to the first draining lymph node of the breast. The procedure involves minimal dissection and division of lymphatic channels compared to formal axillary node clearance (ANC) nevertheless, complications are extensive and confer significant morbidity. They include infection, seroma, hematoma, anaphylaxis, axillary vein injury, shoulder stiffness, limitation in shoulder range of motion, and lymphedema. ![]() Despite these criteria, SNB is still reported to be performed in surgery for DCIS in up to 51% of cases. Sentinel node biopsy (SNB) is therefore currently offered to these patients, with this justification. In planned mastectomy for widespread DCIS in the breast, SNB is also commonly performed as it would not be feasible at a later stage should an invasive component subsequently be found. It is not possible to pre-operatively predict which patients with DCIS will also have occult invasive disease. Parameters which are considered to convey an increased risk are: size >50 mm, presence of extensive calcifications on mammography, and clinical presentation with a palpable lump. ĭue to the characteristic inability to spread, a biopsy to assess metastasis to the lymph nodes in the axilla in DCIS would logically not be considered necessary. However, in approximately 20%-30% of resections for DCIS, invasive cancer is discovered in the post-operative histological specimen. It is well established that invasive cancer correlates with sentinel node metastasis, with an incidence of involved nodes of 15.6% compared with 2% in pure DCIS. The vast majority of cases are diagnosed on screening, with up to 90% of cases being impalpable and asymptomatic. Only 10% are associated with symptoms which include a mass, nipple discharge, and ulceration (Paget’s disease). The incidence of DCIS has increased in recent years, widely attributed to the use of screening programs as mentioned, but also better technological advancements improving diagnosis. Over 60,000 women are diagnosed with DCIS each year in the USA, over 7000 in the UK, and over 2500 in the Netherlands. ![]() ![]() Results: Out of the 48 patients who were identified, four patients had a positive SNB (8%). Two of those patients were found to have micro metastatic disease. None of the patients with a positive SNB had local or systemic recurrence (median follow up: 40 months). One non-breast cancer-related mortality was reported. Two patients were identified who had recurrent disease, one with an invasive recurrence in the breast, and the other with systemic recurrence in the form of bone disease. Both of these patients had a negative SNB.Ĭonclusion: Our results confirm that performing axillary staging with SNB in DCIS is not justifiable, as it does not affect patient outcomes. This supports the emerging evidence that being more surgically conservative may decrease morbidity without affecting patient survival.ĭuctal carcinoma in situ (DCIS) is defined as a type of breast cancer in which there is an abnormal proliferation of cells within the milk ducts which have not invaded beyond the basement membrane to the surrounding tissues. It is, therefore “in situ” cancer, which does not spread to the lymph nodes or distant organs. DCIS accounts for approximately 20% of screen-detected breast tumors in the UK. Methods: Patients with a diagnosis of DCIS who underwent axillary staging with SNB between 2008-2019 in our large volume tertiary centre were identified and included in the study. Background: For invasive breast cancer, sentinel node biopsy (SNB) is an acceptable alternative to axillary node clearance (ANC), although in the recent era, its role is under review. In ductal carcinoma in situ (DCIS), the benefit of SNB is even less well defined. Despite this, guidelines still recommend that it is performed in selected cases of DCIS. The aim of our study was to evaluate the diagnostic value of performing SNB in DCIS. ![]()
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