Is Axillary Assessment of Ductal Carcinoma In Situ of the Breast Necessary in All Cases?

Data de publicació: 01/03/2022 Data Ahead of Print: 10/12/2021

Autors de IIS La Fe

Francisco Ripoll Orts

Autor

Autors aliens a IIS La Fe

Bellver G
Buch E
Adrianzen M
Bermejo B
Burgues O
Julve A
Ortega J

Abstract

BACKGROUND: Staging of the axilla in women with ductal carcinoma in situ (DCIS) is a point of controversy. We aimed to assess whether there is a group of patients in whom axillary assessment can be avoided and whether the likelihood of underdiagnosis of infiltrating carcinoma is sufficient to justify this evaluation. MATERIALS AND METHODS: This was a multicenter, prospective, observational study of patients who were operated on between 2008 and 2018 in three Spanish hospitals, with a diagnosis by radiological or excisional biopsy of DCIS and clinically and radiologically negative axilla. RESULTS: A total of 530 patients with a preoperative diagnosis of DCIS were studied. An axillary assessment was performed in 77% of the patients. In 397 patients, selective sentinel lymph node biopsy was performed. Axillary involvement was found in 7.2% of all patients, which dropped to 2.15% if we only included DCIS diagnosed after a definitive anatomical pathology analysis. Underdiagnosis was correlated with the type of biopsy performed: the risk was 1.34 times as high if the biopsy was performed with a core needle. The risk of lymph node metastasis was higher when there was lymphovascular invasion and when mastectomy was performed. CONCLUSIONS: We propose an axilla management algorithm in patients with a preoperative diagnosis of DCIS. The patients who would benefit from sentinel lymph node biopsy would be those who are not candidates for breast-conserving surgery, those with a BIRADS 5 lesion biopsied by core-needle biopsy, and those whose definitive diagnosis is lymphovascular invasion.

Dades de la publicació

ISSN/ISSNe:: 0022-4804, 1095-8673
Tipus:: Article
Pàgines:: 145-153
DOI:: 10.1016/j.jss.2021.10.006
PubMed:: 34902737
Factor d'Impacte:: 0,697 SCImago ℠
Quartil:: Q1 SCImago ℠

Documents

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Mètriques

Filiacions

Bellver G:: Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
Buch E:: Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
Ripoll F:: Department of General and Digestive Surgery, Hospital Universitario La Fe de Valencia, Valencia, Spain
Adrianzen M:: Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
Bermejo B:: Department of Oncology, Hospital Clínico Universitario de Valencia, Valencia, Spain
Burgues O:: Department of Patology, Hospital Clínico Universitario de Valencia, Valencia, Spain
Julve A:: Department of Radiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
Ortega J:: Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain

University of Valencia, Spain

Keywords

*Axillary lymph node dissection; *Breast cancer; *Ductal carcinoma in situ; *Sentinel lymph node dissection; *Underdiagnosis

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