Holm-Rasmussen Emil Villiam, Jensen Maj-Britt, Balslev Eva, Kroman Niels, Tvedskov Tove Filtenborg
Department of Breast Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Eur J Cancer. 2017 Dec;87:1-9. doi: 10.1016/j.ejca.2017.09.037. Epub 2017 Oct 27.
The risk of axillary metastases in breast cancer patients with only ductal carcinoma in situ (DCIS) is low. Thus, axillary staging with sentinel lymph node biopsy (SLNB) should only be used according to the current guidelines to avoid over-treatment and unnecessary morbidity. In the present study, the use of SLNB in patients with DCIS was evaluated nationally and compared across Danish departments.
A register-based study was conducted using the Danish Breast Cancer Group database. The use of SLNB in DCIS patients according to year of diagnosis, age at diagnosis, size of lesion, Van Nuys classification, palpability, location and department of surgery was evaluated. The chi-squared test was used to test differences between the groups.
Data from 2618 Danish female patients diagnosed with DCIS between 2004 and 2015 were included; 54.3% of patients underwent SLNB. The use of SLNB increased from 26.6% in 2004 to 65.1% in 2015. A total of 1877 (71.7%) patients underwent breast-conserving surgery (BCS), and 577 (22.0%) underwent mastectomy, of which 43.9% and 86.0% respectively had a concomitant SLNB. The SLNB was performed in 23.8% of 454 patients not included by the guidelines. The use of SLNB in combination with BCS differed significantly between departments ranging from 19.7% to 63.8%. A significant difference in the use of SLNB with BCS and mastectomy according to department capacity (high-volume departments versus low-volume departments) was observed.
The use of SLNB in patients with DCIS and adherence to the Danish national guidelines varies among Danish breast surgery departments. To optimise the axillary treatment of patients with DCIS, an improved compliance to the national DCIS guidelines is necessary.
仅患有导管原位癌（DCIS）的乳腺癌患者发生腋窝转移的风险较低。因此，根据当前指南，前哨淋巴结活检（SLNB）进行腋窝分期仅应用于避免过度治疗和不必要的发病率。在本研究中，对丹麦各部门DCIS患者使用SLNB的情况进行了全国性评估并进行比较。
使用丹麦乳腺癌组数据库进行了一项基于登记的研究。根据诊断年份、诊断时年龄、病变大小、范努伊斯分类、可触及性、位置和手术科室评估DCIS患者中SLNB的使用情况。采用卡方检验来检验组间差异。
纳入了2004年至2015年间丹麦2618例诊断为DCIS的女性患者的数据；54.3%的患者接受了SLNB。SLNB的使用率从2004年的26.6%增加到2015年的65.1%。共有1877例（71.7%）患者接受了保乳手术（BCS），577例（22.0%）接受了乳房切除术，其中分别有43.9%和86.0%同时进行了SLNB。在454例不符合指南纳入标准的患者中，23.8%进行了SLNB。各科室之间，SLNB与BCS联合使用的比例差异显著，范围从19.7%到63.8%。根据科室手术量（高手术量科室与低手术量科室）观察到，SLNB与BCS和乳房切除术联合使用存在显著差异。
丹麦各乳腺外科科室对DCIS患者使用SLNB以及遵循丹麦国家指南的情况各不相同。为了优化DCIS患者的腋窝治疗，有必要提高对国家DCIS指南的依从性。
