Role of axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast
1 Clinica Chirurgica II, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
2 Chirurgia Generale, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
3 Chirurgia Generale, Hospital of Venezia, Castello 6776, 30122 Venezia, Italy
4 Chirurgia Generale I, Hospital "Borgo Trento", Piazzale Stefani 1, 37126 Verona, Italy
5 Chirurgia Generale II, Hospital of Vicenza, Via Rodolfi 6, 36100 Vicenza, Italy
6 Chirurgia Generale, Hospital of Conegliano, Via Bisagno 4, 31015 Conegliano, Italy
7 Chirurgia Generale II, Hospital "Borgo Trento", Piazzale Stefani 1, 37126 Verona, Italy
8 Anatomia Patologica, University of Padova, Via Gabelli 61, 35128 Padova, Italy
9 Anatomia Patologica, Hospital of Venezia, Castello 6776, 30122 Venezia, Italy
BMC Cancer 2005, 5:28 doi:10.1186/1471-2407-5-28Published: 11 March 2005
Sentinel lymph node (SLN) biopsy is an effective tool for axillary staging in patients with invasive breast cancer. This procedure has been recently proposed as part of the treatment for patients with ductal carcinoma in situ (DCIS), because cases of undetected invasive foci and nodal metastases occasionally occur. However, the indications for SLN biopsy in DCIS patients are controversial.
The aim of the present study was therefore to assess the incidence of SLN metastases in a series of patients with a diagnosis of pure DCIS.
A retrospective evaluation was made of a series of 102 patients who underwent SLN biopsy, and had a final histologic diagnosis of pure DCIS. Patients with microinvasion were excluded from the analysis. The patients were operated on in five Institutions between 1999 and 2004.
Subdermal or subareolar injection of 30–50 MBq of 99 m-Tc colloidal albumin was used for SLN identification. All sentinel nodes were evaluated with serial sectioning, haematoxylin and eosin staining, and immunohistochemical analysis for cytocheratin.
Only one patient (0.98%) was SLN positive. The primary tumour was a small micropapillary intermediate-grade DCIS and the SLN harboured a micrometastasis. At pathologic revision of the specimen, no detectable focus of microinvasion was found.
Our findings indicate that SLN metastases in pure DCIS are a very rare occurrence. SLN biopsy should not therefore be routinely performed in patients who undergo resection for DCIS. SLN mapping can be performed, as a second operation, in cases in which an invasive component is identified in the specimen. Only DCIS patients who require a mastectomy should have SLN biopsy performed at the time of breast operation, since in these cases subsequent node mapping is not feasible.