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. 2024 Apr 12;26(1):65.
doi: 10.1186/s13058-024-01816-7.

Selective omission of sentinel lymph node biopsy in mastectomy for ductal carcinoma in situ: identifying eligible candidates

Soong June Bae #  1   2 , Yoonwon Kook #  1   2 , Ji Soo Jang  1   2 , Seung Ho Baek  1   2 , Sohyun Moon  1   2 , Jung Hyun Kim  1   2 , Seung Eun Lee  1   2 , Min Ji Kim  1   2 , Sung Gwe Ahn  1   2 , Joon Jeong  3   4
Affiliations

Selective omission of sentinel lymph node biopsy in mastectomy for ductal carcinoma in situ: identifying eligible candidates

Soong June Bae et al. Breast Cancer Res. .

Abstract

Background: Sentinel lymph node biopsy (SLNB) is recommended for patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, given the concerns regarding upstaging and technical difficulties of post-mastectomy SLNB. However, this may lead to potential overtreatment, considering favorable prognosis and de-escalation trends in DCIS. Data regarding upstaging and axillary lymph node metastasis among these patients remain limited.

Methods: We retrospectively reviewed patients with DCIS who underwent mastectomy with SLNB or axillary lymph node dissection at Gangnam Severance Hospital between January 2010 and December 2021. To explore the feasibility of omitting SLNB, we assessed the rates of DCIS upgraded to invasive carcinoma and axillary lymph node metastasis. Binary Cox regression analysis was performed to identify clinicopathologic factors associated with upstaging and axillary lymph node metastasis.

Results: Among 385 patients, 164 (42.6%) experienced an invasive carcinoma upgrade: microinvasion, pT1, and pT2 were confirmed in 53 (13.8%), 97 (25.2%), and 14 (3.6%) patients, respectively. Seventeen (4.4%) patients had axillary lymph node metastasis. Multivariable analysis identified age ≤ 50 years (adjusted odds ratio [OR], 12.73; 95% confidence interval [CI], 1.18-137.51; p = 0.036) and suspicious axillary lymph nodes on radiologic evaluation (adjusted OR, 9.31; 95% CI, 2.06-41.99; p = 0.004) as independent factors associated with axillary lymph node metastasis. Among patients aged > 50 years and/or no suspicious axillary lymph nodes, only 1.7-2.3%) experienced axillary lymph node metastasis.

Conclusions: Although underestimation of the invasive component was relatively high among patients with DCIS undergoing mastectomy, axillary lymph node metastasis was rare. Our findings suggest that omitting SLNB may be feasible for patients over 50 and/or without suspicious axillary lymph nodes on radiologic evaluation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population
Fig. 2
Fig. 2
Pathologic results regarding the upgrade to invasive breast cancer. DCIS, ductal carcinoma in situ
Fig. 3
Fig. 3
The rate of axillary lymph node (ALN) metastasis in (A) patients aged ≤ 50 (B) patients aged > 50, (C) patients without suspicious ALN on radiologic evaluation and (D) patients with suspicious ALN on radiologic evaluation. ALN, axillary lymph node
See this image and copyright information in PMC

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