Is Axillary Assessment of Ductal Carcinoma In Situ of the Breast Necessary in All Cases?
| Autor: | Gemma Bellver, Elvira Buch, Francisco Ripoll, Marcos Adrianzen, Begoña Bermejo, Octavio Burgues, Ana Julve, Joaquin Ortega |
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| Rok vydání: | 2022 |
| Předmět: |
Sentinel Lymph Node Biopsy
Carcinoma Ductal Breast Breast Neoplasms Sentinel lymph node dissection body regions Carcinoma Intraductal Noninfiltrating Ductal carcinoma in situ Axilla Underdiagnosis Humans Female Surgery Lymph Nodes Prospective Studies skin and connective tissue diseases Breast cancer Mastectomy Axillary lymph node dissection Retrospective Studies |
| Zdroj: | The Journal of surgical research r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe instname |
| ISSN: | 0022-4804 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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