Ozkan-Gurdal Sibel, Cabioglu Neslihan, Ozcinar Beyza, Muslumanoglu Mahmut, Ozmen Vahit, Kecer Mustafa, Yavuz Ekrem, Igci Abdullah
Department of Surgery, School of Medicine, Namik Kemal University, Tekirdag, Turkey E-mail :
Asian Pac J Cancer Prev. 2014;15(1):55-60. doi: 10.7314/apjcp.2014.15.1.55.
Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS.
125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM).
88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95%CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion.
Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS.
在过去十年中，对于乳腺单纯导管原位癌（DCIS）患者是否应进行前哨淋巴结活检（SLNB）一直存在争议。本研究的目的是确定与微浸润性疾病相关的因素，并确定DCIS患者进行SLNB的标准。
回顾性分析2000年1月至2008年12月期间接受手术的125例DCIS患者，以确定与DCIS和微浸润性DCIS（DCISM）相关的因素。
88例（70.4%）为单纯DCIS，37例（29.6%）为DCISM。在33例行SLNB的DCIS患者中，1例（3.3%）活检发现孤立肿瘤细胞，而14例DCISM患者中有1例（37.8%）发生微转移（7.1%）。同样，16例单纯DCIS且未行SLNB而行腋窝淋巴结清扫（ALND）的患者均无淋巴结转移。此外，20例行ALND的DCISM患者中，仅1例（5%）有转移。多因素分析显示，粉刺样坏死的存在[相对危险度（RR）=4.1，95%可信区间（CI）=1.6-10.6，P=0.004]和激素受体（ER或PR）阴性（RR=4.0，95%CI=1.5-11，P=0.007）与微浸润显著相关。
我们的研究结果表明，术前诊断为DCIS且伴有粉刺样坏死或激素受体阴性的患者，术后确诊病理更可能存在微浸润成分，应与因DCIS而行乳房切除术的患者一起考虑进行SLNB。
