Schneider Christopher, Trocha Steven, McKinley Brian, Shaw Jamie, Bielby S, Blackhurst Dawn, Jones Yonge, Cornett Wendy
Greenville Hospital System University Medical Center, Department of Surgery, Greenville, South Carolina 29605, USA.
Am Surg. 2010 Sep;76(9):943-6.
Although ductal carcinoma in situ (DCIS) does not require axillary evaluation, controversy exists regarding the use of sentinel lymph node biopsy (SLNB) in patients with DCIS diagnosed by core needle biopsy (CNB). Advocates of concomitant SLNB and lumpectomy cite the low morbidity of SLNB, the high rate of invasive ductal carcinoma in resected specimens, and the positive nodes found in 1 to 2 per cent of patients with resected DCIS despite finding no invasive component. Opponents of this practice cite the complication risk and the improbability of clinically significant axillary recurrence. We therefore proposed to determine our rate of invasive cancer in DCIS diagnosed by CNB and to determine whether SLNB at first operation would decrease return to the operating room. We retrospectively reviewed patients diagnosed with DCIS by CNB from 2003 to 2008. Standard clinicopathological data were collected and analyzed. In 110 patients, the prevalence of invasive cancer on final resection pathology was 13.6 per cent (15 of 110). Of those patients with invasive cancer, 93 per cent (14 of 15) had high-grade DCIS (P = 0.077) by CNB. Seventeen per cent (14 of 82) of patients with high-grade DCIS had invasive cancer. Of 34 patients with SLNB, three (9%) had positive nodes. Fifteen patients required re-excision to obtain negative margins, including 13 patients with invasive cancer. Five patients (4.5%) were spared additional operative intervention by initially performing SLNB. We suggest using concomitant SLNB when a high clinical suspicion of invasive cancer exists, in the presence of a palpable mass, or when mastectomy precludes future SLNB. Intraoperative margin assessment is needed to avoid return to the operating room.
尽管导管原位癌（DCIS）不需要进行腋窝评估，但对于通过粗针活检（CNB）诊断为DCIS的患者是否使用前哨淋巴结活检（SLNB）仍存在争议。同时进行SLNB和乳房肿块切除术的支持者列举了SLNB的低发病率、切除标本中浸润性导管癌的高发生率，以及在切除的DCIS患者中1%至2%发现阳性淋巴结，尽管未发现浸润成分。这种做法的反对者则列举了并发症风险以及临床上显著腋窝复发的可能性不大。因此，我们建议确定通过CNB诊断为DCIS的患者中浸润性癌的发生率，并确定首次手术时进行SLNB是否会减少再次返回手术室的情况。我们回顾性分析了2003年至2008年通过CNB诊断为DCIS的患者。收集并分析了标准的临床病理数据。在110例患者中，最终切除病理上浸润性癌的发生率为13.6%（110例中的15例）。在那些患有浸润性癌的患者中，93%（15例中的14例）通过CNB诊断为高级别DCIS（P = 0.077）。17%（82例中的14例）高级别DCIS患者患有浸润性癌。在34例进行SLNB的患者中，3例（9%）淋巴结阳性。15例患者需要再次切除以获得阴性切缘，其中包括13例浸润性癌患者。5例患者（4.5%）通过最初进行SLNB避免了额外的手术干预。我们建议在高度怀疑存在浸润性癌、可触及肿块或乳房切除术排除未来进行SLNB时，同时进行SLNB。需要术中切缘评估以避免再次返回手术室。
