ASO Author Reflections: Is Sentinel Lymph Node Biopsy Necessary in Patients with Ductal Carcinoma In Situ with Microinva
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Is Sentinel Lymph Node Biopsy Necessary in Patients with Ductal Carcinoma In Situ with Microinvasion Diagnosed on Core Biopsy? April Phantana-angkool, MD, and Richard L. White Jr., MD, FACS Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC
PAST Whether or not to perform sentinel lymph node biopsy (SLNB) when microinvasive cancer or ductal carcinoma in situ with microinvasion (DCISM) is found on core biopsy is unknown. In contrast to pure ductal carcinoma in situ (DCIS), where multiple studies have identified predictors of upstaging, little is known about DCISM. Low rates of lymph node metastasis have been reported in DCISM.1,2 The upstaging rates for DCISM to measurable invasive cancer are variable.3,4 PRESENT The purpose of this study is to identify the rate of upstaging and sentinel lymph node (SLN) metastasis in order to help answer whether SLNB is needed when DCISM is diagnosed on core biopsy. In a cohort of 70 patients with DCISM diagnosis on core biopsy, 30% were upstaged to measurable invasive cancer (T1a or larger) and 7% had SLN metastasis. Of patients with diagnosis of DCISM on final surgical excision, only one patient (2%) had SLN micrometastases.5 Our low rate of lymph node
This ASO Author Reflections is a brief invited commentary on the article ‘‘Ductal Carcinoma In Situ with Microinvasion on Core Biopsy: Evaluating Tumor Upstaging Rate, Lymph Node Metastasis Rate, and Associated Predictive Variables,’’ Ann Surg Oncol. 2019; 26:3874–3882. Ó Society of Surgical Oncology 2020 First Received: 14 October 2019 R. L. White Jr., MD, FACS e-mail: [email protected]; [email protected]
metastases is comparable to earlier studies. We were not able to identify predictive factors for lymph node metastases or upstaging. Given that 93% of patients had no lymph node metastasis, surgeons should consider managing patients with DCISM on core biopsy with partial mastectomy followed by SLNB only if measurable invasive cancer is identified at the time of surgical excision. This approach to decision-making is similar to the care of patients with DCIS. FUTURE A prospective study designed to help identify factors that predict upstaging or SLN metastasis in patients diagnosed with DCSIM on core biopsy is warranted. Furthermore, the significance of positive SLN in the setting of DCISM is unclear. Any future studies will need to address the predictive factors for upstaging and nodal involvement and the long-term outcome of patients with DCISM with involved SLNs. DISCLOSURES
The authors report no conflicts of interest.
REFERENCES 1. Matsen CB, Hirsch A, Eaton A, et al. Extent of microinvasion in ductal carcinoma in situ is not associated with sentinel lymph node metastases. Ann Surg Oncol. 2014;21:3330–3335. 2. Ko BS, Lim WS, Kim HJ, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19:212–216. 3. Namm JP, Mueller J, Kocher
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