Veronesi P, Intra M, Vento A R, Naninato P, Caldarella P, Paganelli G, Viale G
Division of Breast Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy.
Breast. 2005 Dec;14(6):520-2. doi: 10.1016/j.breast.2005.08.007. Epub 2005 Sep 26.
Intraductal carcinoma of the breast (DCIS), by definition, cannot give axillary metastases. Axillary dissection is therefore not indicated. The role of the sentinel lymph node (SLN) biopsy in the management of DCIS has not yet been established. A 6-13% risk of SLN involvement is reported in Literature. The aim of the present study is to assess the role of SLN biopsy in patients with pure DCIS and attempt to identify guidelines for routine practice in managing such patients. From March 1996 to December 2003, 508 consecutive patients with pure DCIS of the breast underwent SLN biopsy at the European Institute of Oncology in Milan. Clinical and pathological data were prospectively collected. In all cases of previous surgery or stereotactic biopsy performed elsewhere all pathological slides were reviewed. Cases with microinvasion were excluded from this investigation. Lymphatic mapping was performed using a radiocolloid technique. Most of the patients underwent conservative surgery and removal of the SLN which was sent for conclusive histology. SLN metastases were detected in 9 out of 508 (1.8%) patients. In five patients only micrometastasis (<2 mm) was detected. Eight patients underwent complete axillary dissection. In none of these patients did we find additional positive axillary lymph nodes. In conclusion, due to the low prevalence of metastatic involvement (1.8%), SLNB should not be considered a standard procedure in the treatment of all patients with DCIS. In pure non-comedo DCIS completely excised by radical surgery with free margins of resection SLNB should be avoided since not only it is unnecessary but could also jeopardize a successive re-SLNB in case of invasive recurrence. A very extensive and accurate histological examination of the tumour in DCIS is compulsory to exclude micro-invasive foci and, finally, to decrease the prevalence of unexpected SLN metastases. SLNB should be considered in case of DCIS where there exists a strong doubt of invasion at the definitive histology, such as large solid tumours or diffuse or pluricentric microcalcifications undergoing mastectomy. Moreover, if the trend is statistically confirmed with a wider population, large comedo-DCIS, presenting superior risk of SLNs metastasis, could be scheduled for SLNB. If the SLN is micrometastatic complete axillary dissection is not unavoidable.
乳腺导管内癌（DCIS），根据定义，不会发生腋窝转移。因此，不建议进行腋窝淋巴结清扫术。前哨淋巴结（SLN）活检在DCIS治疗中的作用尚未确定。文献报道SLN受累的风险为6%-13%。本研究的目的是评估SLN活检在纯DCIS患者中的作用，并试图确定此类患者常规治疗的指导原则。1996年3月至2003年12月，508例连续的纯乳腺DCIS患者在米兰的欧洲肿瘤研究所接受了SLN活检。前瞻性收集临床和病理数据。对于之前在其他地方进行过手术或立体定向活检的所有病例，均复查了所有病理切片。微浸润病例被排除在本研究之外。采用放射性胶体技术进行淋巴绘图。大多数患者接受了保乳手术并切除了SLN，将其送去做最终组织学检查。508例患者中有9例（1.8%）检测到SLN转移。5例患者仅检测到微转移（<2mm）。8例患者接受了完整的腋窝淋巴结清扫术。在这些患者中，我们没有发现其他腋窝阳性淋巴结。总之，由于转移受累的发生率较低（1.8%），SLNB不应被视为所有DCIS患者治疗的标准程序。在通过根治性手术完全切除且切缘阴性的纯非粉刺型DCIS中，应避免SLNB，因为不仅没有必要，而且在侵袭性复发时还可能危及后续的再次SLNB。对DCIS肿瘤进行非常广泛和准确的组织学检查对于排除微浸润灶至关重要，最终可降低意外SLN转移的发生率。对于最终组织学检查存在强烈侵袭怀疑的DCIS病例，如接受乳房切除术的大实性肿瘤或弥漫性或多中心微钙化，应考虑SLNB。此外，如果在更大的人群中得到统计学证实，具有较高SLN转移风险的大粉刺型DCIS可安排进行SLNB。如果SLN为微转移，不一定需要进行完整的腋窝淋巴结清扫术。
