van la Parra R F D, Ernst M F, Barneveld P C, Broekman J M, Rutten M J C M, Bosscha K
Department of Surgery, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands.
Eur J Surg Oncol. 2008 Jun;34(6):631-5. doi: 10.1016/j.ejso.2007.08.003. Epub 2007 Sep 11.
Ductal carcinoma in situ (DCIS) refers to the preinvasive stage of breast carcinoma and should not give axillary metastases. Its diagnosis, however, is subject to sampling errors. The role of sentinel lymph node biopsy (SLNB) in management of DCIS or DCISM (with microinvasion) remains unclear. The purpose of this study was to review our experience with SLNB in DCIS and DCISM.
A review of 51 patients with a diagnosis of DCIS (n=45) or DCISM (n=6), who underwent SLNB and a definitive breast operation between January 1999 and December 2006, was performed.
In 10 patients (19.6%) definitive histology revealed an invasive carcinoma. SLN (micro)metastases were detected in 5 out of 51 patients, of whom 2 had a preoperative diagnosis of grade III DCIS and 3 of DCISM. Three patients (75%) had micrometastases (< 2 mm) only. In 2 patients, histopathology demonstrated a macrometastasis (> 2 mm). All 5 patients underwent axillary dissection. No additional positive axillary lymph nodes were found.
In case of a preoperative diagnosis of grade III DCIS or a grade II DCIS with comedo necrosis and DCIS with microinvasion, an SLNB procedure has to be considered because in almost 20% of the patients an invasive carcinoma is found after surgery. In this case the SLNB procedure becomes less reliable after a lumpectomy or ablation has been performed. SLN (micro)metastases were detected in nearly 10% of the patients. The prognostic significance of individual tumour cells remains unclear.
导管原位癌（DCIS）是指乳腺癌的浸润前期，不应出现腋窝转移。然而，其诊断存在抽样误差。前哨淋巴结活检（SLNB）在DCIS或伴有微浸润的DCIS（DCISM）治疗中的作用仍不明确。本研究的目的是回顾我们在DCIS和DCISM中进行SLNB的经验。
回顾性分析了1999年1月至2006年12月期间51例诊断为DCIS（n = 45）或DCISM（n = 6）并接受了SLNB及确定性乳房手术的患者。
10例患者（19.6%）的最终组织学检查显示为浸润性癌。51例患者中有5例检测到前哨淋巴结（微）转移，其中2例术前诊断为III级DCIS，3例为DCISM。3例患者（75%）仅出现微转移（<2 mm）。2例患者组织病理学显示为大转移（>2 mm）。所有5例患者均接受了腋窝清扫术，未发现其他腋窝阳性淋巴结。
对于术前诊断为III级DCIS或伴有粉刺样坏死的II级DCIS以及伴有微浸润的DCIS患者，应考虑进行SLNB，因为几乎20%的患者术后会发现浸润性癌。在这种情况下，在进行肿块切除或消融术后，SLNB的可靠性会降低。近10%的患者检测到前哨淋巴结（微）转移。单个肿瘤细胞的预后意义仍不明确。
