Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep;26(9):2738-2746.
doi: 10.1245/s10434-019-07475-9. Epub 2019 May 30.

Is Sentinel Lymph Node Biopsy Required for a Core Biopsy Diagnosis of Ductal Carcinoma In Situ with Microinvasion?

Meghan R Flanagan  1 , Michelle Stempel  1 , Edi Brogi  2 , Monica Morrow  1 , Hiram S Cody 3rd  3
Affiliations

Is Sentinel Lymph Node Biopsy Required for a Core Biopsy Diagnosis of Ductal Carcinoma In Situ with Microinvasion?

Meghan R Flanagan et al. Ann Surg Oncol. 2019 Sep.

Abstract

Background: Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM.

Methods: Overall, 369 consecutive patients (2007-2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging.

Results: Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1.

Conclusions: Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

Dr. Monica Morrow has received speaking honoraria from Roche and Genomic Health. Meghan R. Flanagan, Michelle Stempel, Edi Brogi, and Hiram S. Cody III have no potential conflicts of interest to disclose.

Figures

FIG. 1
FIG. 1
(a) Suspected DCISM: here, a cluster of three cells is in the stroma adjacent to a duct containing DCIS (*). Although suspicious, this focus is not definitely diagnostic of microinvasion, and could represent prominent endothelial cells in a small periductal vessel. Work-up with appropriate myoepithelial and/or epithelial markers may help to resolve the differential diagnosis in similar cases. (b) Definite DCISM: here, the microinvasion comprises a cluster of 15–20 neoplastic cells devoid of myoepithelium, spanning <1 mm in the lymphocyte-rich stroma between two ducts (*) harboring DCIS. DCISM ductal carcinoma in situ with microinvasion, DCIS ductal carcinoma in situ
See this image and copyright information in PMC

Comment in

References

    1. Gojon H, Fawunmi D, Valachis A. Sentinel lymph node biopsy in patients with microinvasive breast cancer: a systematic review and meta-analysis. Eur J Surg Oncol. 2014;40(1):5–11. - PubMed
    1. Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19(1):212–6. - PubMed
    1. Kapoor NS, Shamonki J, Sim MS, Chung CT, Giuliano AE. Impact of multifocality and lymph node metastasis on the prognosis and management of microinvasive breast cancer. Ann Surg Oncol. 2013;20(8):2576–81. - PubMed
    1. Margalit DN, Sreedhara M, Chen YH, Catalano PJ, Nguyen PL, Golshan M, et al. Microinvasive breast cancer: ER, PR, and HER-2/neu status and clinical outcomes after breast-conserving therapy or mastectomy. Ann Surg Oncol. 2013;20(3):811–8. - PubMed
    1. Matsen CB, Hirsch A, Eaton A, Stempel M, Heerdt A, Van Zee KJ, et al. Extent of microinvasion in ductal carcinoma in situ is not associated with sentinel lymph node metastases. Ann Surg Oncol. 2014;21(10):3330–5. - PMC - PubMed

MeSH terms