Don and Erika Wallace Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
J Oncol Pract. 2011 Sep;7(5):309-13. doi: 10.1200/JOP.2010.000096. Epub 2011 Jul 27.
Axillary staging via sentinel node biopsy (SLNB) in patients with ductal carcinoma in situ with microinvasion (DCISM) is routinely performed but remains controversial with regard to the risk-benefit ratio.
Retrospective single-institution review of patients with diagnosis of DCISM (invasive tumor ≤ 0.1 cm). Age, clinicopathologic data, and follow-up were recorded.
Of 90 patients, 33% were diagnosed by core needle biopsy (CNB), 37% by excisional biopsy, and 29% were upstaged from DCIS on CNB to DCISM at final operation. Three (10%) of 30 patients with DCISM on CNB were upstaged to invasive cancer on final pathology. Median age at diagnosis was 58.9 years (range: 30-89). Lumpectomy was performed in 45% of patients and mastectomy in 55%. Mean number of sentinel nodes was 2.59 (SE 0.17). Six (6.9%) of 87 patients with DCISM as final diagnosis had a positive SLNB (four lumpectomies, two mastectomies). There was no correlation with any clinicopathologic features, including palpable DCIS, DCIS grade/necrosis, or age at diagnosis. All six SLNB-positive patients had a complete axillary dissection; two had additional disease. Median follow-up time was 74.2 months (range: 2-169). In-breast recurrence was seen in three patients (5%), regardless of SLN status, DCIS grade, or necrosis. Two patients developed distant metastasis. Overall survival was 94.19% at 5 years for DCISM and 100% for DCISM with nodal disease.
DCISM comprises 0.6% of breast cancer diagnoses at our institution. There is a low likelihood of nodal spread; however, a lack of identifiable clinicopathologic features associated with a positive SLNB limits selective SLNB use.
对于微浸润性导管原位癌（DCISM）患者，通过前哨淋巴结活检（SLNB）进行腋窝分期是常规操作，但对于风险效益比仍存在争议。
回顾性分析诊断为 DCISM（浸润性肿瘤≤0.1cm）的患者的单机构数据。记录年龄、临床病理数据和随访情况。
90 例患者中，33%通过核心针活检（CNB）诊断，37%通过切除活检诊断，29%在最终手术时从 CNB 诊断为 DCIS 升级为 DCISM。30 例 CNB 诊断为 DCISM 的患者中有 3 例（10%）在最终病理检查中升级为浸润性癌。诊断时的中位年龄为 58.9 岁（范围：30-89）。45%的患者行保乳术，55%的患者行乳房切除术。平均前哨淋巴结数量为 2.59（SE 0.17）。87 例最终诊断为 DCISM 的患者中，有 6 例（6.9%）SLNB 阳性（4 例保乳术，2 例乳房切除术）。与任何临床病理特征均无相关性，包括可触及的 DCIS、DCIS 分级/坏死或诊断时的年龄。所有 6 例 SLNB 阳性的患者均行完整腋窝清扫术，其中 2 例患者有额外的疾病。中位随访时间为 74.2 个月（范围：2-169）。3 例（5%）患者无论 SLN 状态、DCIS 分级或坏死情况如何，均出现乳房内复发。2 例患者发生远处转移。DCISM 的 5 年总生存率为 94.19%，伴有淋巴结疾病的 DCISM 为 100%。
本机构诊断为 DCISM 的乳腺癌占比为 0.6%。淋巴结转移的可能性较低；然而，缺乏与 SLNB 阳性相关的可识别临床病理特征限制了选择性 SLNB 的使用。
