Sentinel node biopsy in ductal carcinoma in situ patients
- PMID: 10674443
- DOI: 10.1007/s10434-000-0015-z
Sentinel node biopsy in ductal carcinoma in situ patients
Abstract
Background: Sentinel lymph node (SLN) mapping is an effective and accurate method of evaluating the regional lymph nodes in breast cancer patients. The SLN is the first node that receives lymphatic drainage from the primary tumor. Patients with micrometastatic disease, previously undetected by routine hematoxylin and eosin (H&E) stains, are now being detected with the new technology of SLN biopsy, followed by a more detailed examination of the SLN that includes serial sectioning and cytokeratin immunohistochemical (CK IHC) staining of the nodes.
Methods: At Moffitt Cancer Center, 87 patients with newly diagnosed pure ductal carcinoma in situ (DCIS) lesions were evaluated by using CK IHC staining of the SLN. Patients with any focus of microinvasive disease, detected on diagnostic breast biopsy by routine H&E, were excluded from this study. DCIS patients, with biopsy-proven in situ tumor by routine H&E stains, underwent intraoperative lymphatic mapping, using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised SLNs were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. All SLNs that had only CK-positive cells were subsequently confirmed malignant by a more detailed histological examination of the nodes.
Results: CK IHC staining was performed on 177 SLNs in 87 DCIS breast cancer patients. Five of the 87 DCIS patients (6%) had positive SLNs. Three of these patients were only CK positive and two were both H&E and CK positive. Therefore, routine H&E staining missed microinvasive disease in three of five DCIS patients with positive SLNs. In addition, DCIS patients with occult micrometastatic disease to the SLN underwent a complete axillary lymph node dissection, and the SLNs were the only nodes found to have metastatic disease. Of interest, four of the five node-positive patients had comedo carcinoma associated with the DCIS lesion, and one patient had a large 9.5-cm low grade cribriform and micropapillary type of DCIS.
Conclusions: This study confirms that lymphatic mapping in breast cancer patients with DCIS lesions is a technically feasible and a highly accurate method of staging patients with undetected micrometastatic disease to the regional lymphatic basin. This procedure can be performed with minimal morbidity, because only one or two SLNs, which are at highest risk for containing metastatic disease, are removed. This allows the pathologist to examine the one or two lymph nodes with greater detail by using serial sectioning and CK IHC staining of the SLNs. Because most patients with DCIS lesions detected by routine H&E stains do not have regional lymph node metastases, these patients can safely avoid the complications associated with a complete axillary lymph node dissection and systemic chemotherapy. However, DCIS patients with occult micrometastases of the regional lymphatic basin can be staged with higher accuracy and treated in a more selective fashion.
Comment in
-
Is it really duct carcinoma in situ?Ann Surg Oncol. 2001 Sep;8(8):617-9. doi: 10.1007/s10434-001-0617-0. Ann Surg Oncol. 2001. PMID: 11569773 No abstract available.
Similar articles
-
Sentinel node biopsy and cytokeratin staining for the accurate staging of 478 breast cancer patients.Am Surg. 1999 Jun;65(6):500-5; discussion 505-6. Am Surg. 1999. PMID: 10366202
-
Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer.Ann Surg. 1998 May;227(5):645-51; discussion 651-3. doi: 10.1097/00000658-199805000-00005. Ann Surg. 1998. PMID: 9605656 Free PMC article.
-
Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node.Ann Surg Oncol. 1999 Jan-Feb;6(1):95-101. doi: 10.1007/s10434-999-0095-3. Ann Surg Oncol. 1999. PMID: 10030421
-
Ductal carcinoma in situ: value of sentinel lymph node biopsy.J Surg Oncol. 2006 Oct 1;94(5):426-30. doi: 10.1002/jso.20578. J Surg Oncol. 2006. PMID: 16967457 Review.
-
Point: sentinel lymph node biopsy is indicated for patients with DCIS.J Natl Compr Canc Netw. 2003 Apr;1(2):199-206. doi: 10.6004/jnccn.2003.0018. J Natl Compr Canc Netw. 2003. PMID: 19768878 Review.
Cited by
-
Sentinel lymph node biopsy and management of the axilla in ductal carcinoma in situ.J Natl Cancer Inst Monogr. 2010;2010(41):145-9. doi: 10.1093/jncimonographs/lgq026. J Natl Cancer Inst Monogr. 2010. PMID: 20956820 Free PMC article. Review.
-
Sentinel lymph node biopsy in patients with breast ductal carcinoma in situ: Chinese experiences.Oncol Lett. 2015 Sep;10(3):1932-1938. doi: 10.3892/ol.2015.3480. Epub 2015 Jul 10. Oncol Lett. 2015. PMID: 26622778 Free PMC article.
-
Is Sentinel Lymph Node Dissection Warranted for Patients with a Diagnosis of Ductal Carcinoma In Situ?Ann Surg Oncol. 2015 Dec;22(13):4270-9. doi: 10.1245/s10434-015-4547-7. Epub 2015 Apr 24. Ann Surg Oncol. 2015. PMID: 25905585 Free PMC article.
-
Ductal carcinoma in situ and sentinel lymph node biopsy.J Breast Cancer. 2011 Dec;14(4):301-7. doi: 10.4048/jbc.2011.14.4.301. Epub 2011 Dec 27. J Breast Cancer. 2011. PMID: 22323917 Free PMC article.
-
Sentinel lymph node biopsy progress in surgical treatment of cancer.Langenbecks Arch Surg. 2004 Nov;389(6):532-50. doi: 10.1007/s00423-004-0484-9. Epub 2004 Jun 9. Langenbecks Arch Surg. 2004. PMID: 15197548 Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials