Sentinel node biopsy is important in mastectomy for ductal carcinoma in situ
Dominguez FJ et al. - In a trial to determine the utility of sentinel node biopsy (SNB) for ductal carcinoma in situ (DCIS) and its potential to avoid axillary lymph node dissection (ALND) in patients undergoing mastectomy for DCIS, it was found that 11% of patients undergoing mastectomy for DCIS had invasive cancer on final pathology; use of SNB during mastectomy for DCIS allowed nearly all such patients to avoid axillary dissection Methods- A review was conducted of 179 patients who underwent mastectomy with sentinel node biopsy for DCIS without invasion or microinvasion on premastectomy pathology review
Results- Sentinel node identification rate was 98.9%
- 11.3% of mastectomies for DCIS had a positive SNB: 2 micrometastasis (pN1mi) and 18 isolated tumor cells [pN0(i+)]
- Unsuspected invasive cancer was found in 11.2% of the mastectomies, 8 T1mic, 5 T1a, 3 T1b, and 4 T1c tumors
- Sentinel nodes were identified in 19 of 20 patients with invasive cancer and 4 were positive: 1 pN1mi and 3 pN0(i+)
- 18 of 19 patients with unsuspected invasive cancer were able to avoid axillary dissection on the basis of SNB results
- Of the 159 patients whose final pathology revealed DCIS without invasion, a sentinel node was identified in 99.4%
- SNB was positive in 16 patients: 1 pN1mi and 15 pN0(i+)
- 3 patients underwent ALND on the basis of positive SNBs and in each the SNB was the only positive node
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