Tan Jensen C C, McCready David R, Easson Alexandra M, Leong Wey L
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Ann Surg Oncol. 2007 Feb;14(2):638-45. doi: 10.1245/s10434-006-9211-9. Epub 2006 Nov 14.
Sentinel lymph node biopsy (SLNB) is a widely accepted alternative to axillary lymph node dissection in invasive breast cancer. Its role in ductal carcinoma-in-situ (DCIS) is unclear. The purpose of this study was to determine factors associated with the subsequent diagnosis of invasive disease and to determine the role of SLNB when performing a mastectomy for DCIS.
A retrospective study was conducted of all mastectomies performed on patients with a preoperative diagnosis of DCIS between 2000 and 2005 at a single tertiary-care institution.
Ninety mastectomies for DCIS were included, 54 (60%) of which were performed with concurrent SLNB. Of 44 patients diagnosed preoperatively with DCIS by core biopsy only, 34 patients (63%) had a concurrent SLNB, while 10 patients (28%) were treated with mastectomy alone (P < .01). Overall, 30 patients (33%) had invasive disease, 22 of whom received concurrent SLNB. Seven SLNB patients (13%) had positive SLNs. On univariate analysis, multifocality (P = .03), multicentricity (P = .01), comedonecrosis (P = .01), and diagnosis by core biopsy (P < .001) were associated with invasive disease on pathology. On multivariate analysis, comedonecrosis (P = .04) and diagnosis by core biopsy (P < .01) were independent predictors for invasion. There was no statistically significant predictor for sentinel lymph node metastasis.
Approximately one-third of patients with DCIS treated with mastectomy at our institution later had invasive disease, and factors associated with invasion have been identified. On the basis of our results, routine SLNB is recommended in this patient population.
前哨淋巴结活检（SLNB）是浸润性乳腺癌腋窝淋巴结清扫术广泛接受的替代方法。其在导管原位癌（DCIS）中的作用尚不清楚。本研究的目的是确定与随后浸润性疾病诊断相关的因素，并确定在为DCIS行乳房切除术时SLNB的作用。
对2000年至2005年在一家三级医疗机构对术前诊断为DCIS的患者进行的所有乳房切除术进行回顾性研究。
纳入了90例DCIS乳房切除术，其中54例（60%）同时进行了SLNB。在仅通过粗针活检术前诊断为DCIS的44例患者中，34例（63%）同时进行了SLNB，而10例（28%）仅接受了乳房切除术（P <.01）。总体而言，30例（33%）有浸润性疾病，其中22例接受了同时SLNB。7例SLNB患者（13%）前哨淋巴结阳性。单因素分析显示，多灶性（P =.03）、多中心性（P =.01）、粉刺样坏死（P =.01）和粗针活检诊断（P <.001）与病理上的浸润性疾病相关。多因素分析显示，粉刺样坏死（P =.04）和粗针活检诊断（P <.01）是浸润的独立预测因素。没有统计学上显著的前哨淋巴结转移预测因素。
在我们机构接受乳房切除术治疗的DCIS患者中，约三分之一后来发生了浸润性疾病，并且已确定了与浸润相关的因素。根据我们的结果，建议在该患者群体中常规进行SLNB。
