An Argument Against Routine Sentinel Node Mapping for DCIS

Farkas, E. A.; Stolier, A. J.; Teng, S. C.; Bolton, J. S.; Fuhrman, G. M.
January 2004
American Surgeon;Jan2004, Vol. 70 Issue 1, p13
Academic Journal
Indications for sentinel lymph node mapping (SLNM) for patients with ductal carcinoma in situ (DCIS) of the breast are controversial. We reviewed our institutional experience with SLNM for DCIS to determine the node positive rate and clarify indications for nodal staging in patients with DCIS. Since 1998 we have used SLNM to stage breast cancer patients using both blue dye and radiocolloid. In DCIS patients, SLNM has been reserved for patients considered at high risk for harboring coexistent invasive carcinoma or treated by mastectomy. All sentinel nodes were evaluated with serial sectioning, hematoxylin and eosin staining, and immunohistochemical evaluation for cytokeratins. We identified 44 patients with 46 cases of DCIS (two patients with bilateral disease). SLNM identified at least one sentinel node in all cases. In all cases, the sentinel node(s) were negative for axillary metastasis. We calculated the binomial probability of observing 0 of 46 cases as negative when the expected incidence according to published reports in the surgical literature was 13 per cent and found a P value of <0.01. Based on this case-series observation, we conclude SLNM should not be routinely performed for patients with DCIS. We now use SLNM only for DCIS patients treated by mastectomy.


Related Articles

  • Detection of MAGE-A3 in breast cancer patients’ sentinel lymph nodes. Wascher, R A; Bostick, P J; Huynh, K T; Turner, R; Qi, K; Giuliano, A E; Hoon, D S B // British Journal of Cancer;11/1/2001, Vol. 85 Issue 9, p1340 

    The detection of occult metastatic breast cancer cells by RT-PCR is limited by the poor specificity of most tumour mRNA markers. MAGE-A3 is a highly specific tumour mRNA marker that is not expressed in non-cancer cells. This study assesses MAGE-A3 mRNA as a molecular marker for the detection of...

  • Staging the Axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer. Ruano, R.; Ramos, M.; Garcia-Talavera, J.; Serrano, E.; Arriba, A.; Gonzalez-Orus, J.; Iglesias, M.; Macias, M. // European Journal of Nuclear Medicine & Molecular Imaging;Jul2008, Vol. 35 Issue 7, p1299 

    To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer. In the period 2001–2006, 138...

  • Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Kvistad, K. A.; Rydland, J.; Smethurst, H. -B.; Lundgren, S.; Fjøsne, H. E.; Haraldseth, O.; Fjøsne, H E // European Radiology;Sep2000, Vol. 10 Issue 9, p1464 

    Metastatic involvement of axillary lymph nodes is one of the most important prognostic variables in breast cancer. The aim of our work was to study the value of dynamic contrast-enhanced MR imaging in revealing axillary lymph node metastases from breast cancer. A total of 65 patients with...

  • Importance of staging of breast cancer and role of contrast ultrasound. Rizzatto, Giorgio; Martegani, Alberto; Chersevani, Roberta; Macorig, Donatella; Vrtovec, Marietica; Aiani, Luca; Tufarulo, Loredana // European Radiology;Dec2001 Supplement 3, Vol. 11, pE47 

    This article discusses the importance of staging of breast cancer and role of contrast ultrasound. High-resolution ultrasound (US) can be used to evaluate most of the parameters required for breast cancer staging. However, there are major problems in the accurate definition of tumor vascularity...

  • Comparison of Pathologist-Detected and Automated Computer-Assisted Image Analysis Detected Sentinel Lymph Node Micrometastases in Breast Cancer. Weaver, Donald L.; Krag, David N.; Manna, Edward A.; Ashikaga, Taka; Harlow, Seth P.; Bauer, Kenneth D. // Modern Pathology;Nov2003, Vol. 16 Issue 11, p1159 

    Sentinel lymph node biopsy has stimulated interest in identification of micrometastatic disease in lymph nodes, but identifying small clusters of tumor cells or single tumor cells in lymph nodes can be tedious and inaccurate. The optimal method of detecting micrometastases in sentinel nodes has...

  • Use and Limitations of a Nomogram Predicting the Likelihood of Non-Sentinel Node Involvement After a Positive Sentinel Node Biopsy in Breast Cancer Patients. Kocsis, Lajos; Svébis, Mihaly; Boross, Gábor; Sinkó, Mária; Maráz, Róbert; Rajtár, Mária; Cserni, Gábor // American Surgeon;Nov2004, Vol. 70 Issue 11, p1019 

    After a positive sentinel lymph node (SLN) biopsy, some patients may be considered to have a very low risk of non-SLN involvement and could be candidates for axillary sparing. The aim of this study was to validate the nomogram created at the Memorial Sloan-Kettering Cancer Center (MSKCC) for the...

  • Axillary sentinel lymph node micrometastases with extracapsular extension: a distinct pattern of breast cancer metastasis? Cserni, G. // Journal of Clinical Pathology;Jan2008, Vol. 61 Issue 1, p115 

    Aims: To examine the frequency of extracapsular extension (ECE) of sentinel lymph node (SLN) metastases in breast cancer according to metastasis size, and to characterise ECE in micometastases. Methods: If initially negative, SLNs were examined by step-sectioning and immunohistochemistry....

  • Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Sapino, A; Cassoni, P; Zanon, E; Fraire, F; Croce, S; Coluccia, C; Donadio, M; Bussolati, G // British Journal of Cancer;3/10/2003, Vol. 88 Issue 5, p702 

    The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the...

  • Comprehensive Examination of Sentinel Lymph Node in Breast Cancer: A Solution Without a Problem? Falconieri, Giovanni; Pizzolitto, Stefano; Gentile, Giuliana // International Journal of Surgical Pathology;Jan2006, Vol. 14 Issue 1, p1 

    Although several methods have been devised to examine sentinel lymph node (SLN) specimens in breast cancer, the extent of examination and whether it should routinely include multilevel sectioning to detect micrometastases (MM) (<2.0 mm) is still debated. In this study all "positive" SLN biopsies...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics