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  Global Journal of Surgery. Volume 1, Issue 1 (2010) pp. 41-47
  Research Article
Utility of Sentinel Node Biopsy in Ductal Carcinoma in Situ (DCIS)
  M. Catherine Leea, Kandace P. McGuireb, John V. Kiluka, Nazanin Khakpoura and Christine Larongaa  
a Don & Erika Wallace Comprehensive Breast Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, Florida 33612, USA
bDepartment of Surgery, Division of Surgical Oncology, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, USA

  Introduction: As most DCIS is diagnosed on stereotactic biopsy, this study examines the use of sentinel lymph node biopsy at the time of resection for DCIS diagnosed by core needle. Experimental: An IRB-approved search of a single-institution breast cancer database from 1997-2008 revealed 4553 DCIS patients. 366 were diagnosed on core and treated with breast surgery and lymphatic mapping. Chi-square, Fisher's exact and t-test analyses were performed. Results: 260/366 (76.5%) had DCIS; 86 patients (23.5%) were upstaged to invasive carcinoma on final pathology. Median invasive tumor size was 0.4cm (mean 0.28cm). Median patient age was 56 (range 25-90). Mean follow-up was 89.9 months (range 1-345). Surgical treatment was lumpectomy in 206/366 (56%) and mastectomy in 160/366 (44%); 2 patients failed mapping (0.05%). Of the 86/366 upstaged patients, 49/206 (23.8%) had lumpectomy and 37/160 (23.1%) had mastectomy. 22/366 patients (6%) with DCIS on core biopsy had a positive node; 8/206 (3.9%) patients had lumpectomy and 14/160 (8.8%) had mastectomy. 72% of node-positive patients had invasive carcinoma on final pathology. 20/22 (90.1%) node-positive patients had comedonecrosis. There were no significant differences with regards to age, race, tumor grade, or ER/PR status with node positivity. All 11 presenting with palpable disease had invasion on final pathology. Three percent (12/366) developed distant disease; there were no axillary recurrences. Conclusions: The incidence of nodal disease in DCIS patients diagnosed by core is 6% with an upstaging rate of 23.5%. Sentinel node biopsy at the time of mastectomy for DCIS has practical implications in avoiding axillary dissection, but the risks of lymphatic mapping may outweigh the benefits except in the presence of comedonecrosis on core biopsy or palpable in-breast disease.
  DCIS; Sentinel node biopsy; Breast cancer; Axillary surgery; Comedonecrosis  

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