Sentinel lymph node biopsy in patients with a needle core biopsy diagnosis of ductal carcinoma in situ: is it justified?

Hdl Handle:
http://hdl.handle.net/10147/207588
Title:
Sentinel lymph node biopsy in patients with a needle core biopsy diagnosis of ductal carcinoma in situ: is it justified?
Authors:
Doyle, B; Al-Mudhaffer, M; Kennedy, M M; O'Doherty, A; Flanagan, F; McDermott, E W; Kerin, M J; Hill, A D; Quinn, C M
Affiliation:
Irish National Breast Screening Programme and Department of Histopathology, St, Vincent's University Hospital, Dublin, Ireland. b.doyle@beatson.gla.ac.uk
Citation:
J Clin Pathol. 2009 Jun;62(6):534-8. Epub 2009 Feb 3.
Journal:
Journal of clinical pathology
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207588
DOI:
10.1136/jcp.2008.061457
PubMed ID:
19190009
Abstract:
BACKGROUND: The incidence of ductal carcinoma in situ (DCIS) has increased markedly with the introduction of population-based mammographic screening. DCIS is usually diagnosed non-operatively. Although sentinel lymph node biopsy (SNB) has become the standard of care for patients with invasive breast carcinoma, its use in patients with DCIS is controversial. AIM: To examine the justification for offering SNB at the time of primary surgery to patients with a needle core biopsy (NCB) diagnosis of DCIS. METHODS: A retrospective analysis was performed of 145 patients with an NCB diagnosis of DCIS who had SNB performed at the time of primary surgery. The study focused on rates of SNB positivity and underestimation of invasive carcinoma by NCB, and sought to identify factors that might predict the presence of invasive carcinoma in the excision specimen. RESULTS: 7/145 patients (4.8%) had a positive sentinel lymph node, four macrometastases and three micrometastases. 6/7 patients had invasive carcinoma in the final excision specimen. 55/145 patients (37.9%) with an NCB diagnosis of DCIS had invasive carcinoma in the excision specimen. The median invasive tumour size was 6 mm. A radiological mass and areas of invasion <1 mm, amounting to "at least microinvasion" on NCB were predictive of invasive carcinoma in the excision specimen. CONCLUSIONS: SNB positivity in pure DCIS is rare. In view of the high rate of underestimation of invasive carcinoma in patients with an NCB diagnosis of DCIS in this study, SNB appears justified in this group of patients.
Language:
eng
MeSH:
Biopsy, Needle; Breast/*pathology; Breast Neoplasms/*pathology/radiography/surgery; Carcinoma in Situ/*pathology/radiography/surgery; Carcinoma, Ductal, Breast/*pathology/radiography/surgery; Carcinoma, Lobular/pathology/radiography/surgery; Chi-Square Distribution; Early Detection of Cancer; Female; Humans; Lymphatic Metastasis; Mammography; Neoplasm Staging; *Patient Selection; Predictive Value of Tests; Retrospective Studies; Risk; *Sentinel Lymph Node Biopsy
ISSN:
1472-4146 (Electronic); 0021-9746 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorDoyle, Ben_GB
dc.contributor.authorAl-Mudhaffer, Men_GB
dc.contributor.authorKennedy, M Men_GB
dc.contributor.authorO'Doherty, Aen_GB
dc.contributor.authorFlanagan, Fen_GB
dc.contributor.authorMcDermott, E Wen_GB
dc.contributor.authorKerin, M Jen_GB
dc.contributor.authorHill, A Den_GB
dc.contributor.authorQuinn, C Men_GB
dc.date.accessioned2012-02-01T10:32:11Z-
dc.date.available2012-02-01T10:32:11Z-
dc.date.issued2012-02-01T10:32:11Z-
dc.identifier.citationJ Clin Pathol. 2009 Jun;62(6):534-8. Epub 2009 Feb 3.en_GB
dc.identifier.issn1472-4146 (Electronic)en_GB
dc.identifier.issn0021-9746 (Linking)en_GB
dc.identifier.pmid19190009en_GB
dc.identifier.doi10.1136/jcp.2008.061457en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207588-
dc.description.abstractBACKGROUND: The incidence of ductal carcinoma in situ (DCIS) has increased markedly with the introduction of population-based mammographic screening. DCIS is usually diagnosed non-operatively. Although sentinel lymph node biopsy (SNB) has become the standard of care for patients with invasive breast carcinoma, its use in patients with DCIS is controversial. AIM: To examine the justification for offering SNB at the time of primary surgery to patients with a needle core biopsy (NCB) diagnosis of DCIS. METHODS: A retrospective analysis was performed of 145 patients with an NCB diagnosis of DCIS who had SNB performed at the time of primary surgery. The study focused on rates of SNB positivity and underestimation of invasive carcinoma by NCB, and sought to identify factors that might predict the presence of invasive carcinoma in the excision specimen. RESULTS: 7/145 patients (4.8%) had a positive sentinel lymph node, four macrometastases and three micrometastases. 6/7 patients had invasive carcinoma in the final excision specimen. 55/145 patients (37.9%) with an NCB diagnosis of DCIS had invasive carcinoma in the excision specimen. The median invasive tumour size was 6 mm. A radiological mass and areas of invasion <1 mm, amounting to "at least microinvasion" on NCB were predictive of invasive carcinoma in the excision specimen. CONCLUSIONS: SNB positivity in pure DCIS is rare. In view of the high rate of underestimation of invasive carcinoma in patients with an NCB diagnosis of DCIS in this study, SNB appears justified in this group of patients.en_GB
dc.language.isoengen_GB
dc.subject.meshBiopsy, Needleen_GB
dc.subject.meshBreast/*pathologyen_GB
dc.subject.meshBreast Neoplasms/*pathology/radiography/surgeryen_GB
dc.subject.meshCarcinoma in Situ/*pathology/radiography/surgeryen_GB
dc.subject.meshCarcinoma, Ductal, Breast/*pathology/radiography/surgeryen_GB
dc.subject.meshCarcinoma, Lobular/pathology/radiography/surgeryen_GB
dc.subject.meshChi-Square Distributionen_GB
dc.subject.meshEarly Detection of Canceren_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLymphatic Metastasisen_GB
dc.subject.meshMammographyen_GB
dc.subject.meshNeoplasm Stagingen_GB
dc.subject.mesh*Patient Selectionen_GB
dc.subject.meshPredictive Value of Testsen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisken_GB
dc.subject.mesh*Sentinel Lymph Node Biopsyen_GB
dc.titleSentinel lymph node biopsy in patients with a needle core biopsy diagnosis of ductal carcinoma in situ: is it justified?en_GB
dc.contributor.departmentIrish National Breast Screening Programme and Department of Histopathology, St, Vincent's University Hospital, Dublin, Ireland. b.doyle@beatson.gla.ac.uken_GB
dc.identifier.journalJournal of clinical pathologyen_GB
dc.description.provinceLeinster-

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