Miller-Ocuin Jennifer L, Howard-McNatt Marissa, Levine Edward A, Chiba Akiko
12280 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Division of Surgical Oncology, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Am Surg. 2020 Aug;86(8):955-957. doi: 10.1177/0003134820942164. Epub 2020 Aug 29.
Current treatment guidelines for ductal carcinoma in situ (DCIS) treated with mastectomy recommend sentinel lymph node biopsy (SLNB). In the modern era, there is a trend toward minimizing invasive staging and treatment of the axilla. In this study, we seek to determine the role of SLNB in patients undergoing mastectomy for the treatment of DCIS.
Patients undergoing mastectomy were identified from our institution's SLNB database from 2012 to 2016. Patients were included if core needle biopsy demonstrated DCIS. Patient demographics, tumor characteristics, and pathologic variables were abstracted.
Of 187 patients undergoing mastectomy with SLNB from 2012 to 2016 for DCIS or invasive ductal carcinoma, 39 (21%) were diagnosed with DCIS on core biopsy. Mean age was 57 years. 70% were Caucasian, 18% were African American, 8% were Asian, and the remaining 5% were unknown. One patient (3%) had positive nodes on SLNB and underwent axillary lymph node dissection. Of those with DCIS on core biopsy, 14 (36%) were upstaged to invasive disease on final surgical pathology, including the patient with positive SLNB. Of the remaining 25 (64%) patients with DCIS on final pathology, 0 (0%) had SLNB positivity.
Only 3% of patients with DCIS undergoing mastectomy were found to have SLN metastases. However, a significant number of patients (36%) were upstaged due to invasive cancer. Although limited by a small sample size, our results suggest that SLNB should still be recommended to patients undergoing mastectomy for DCIS on core needle biopsy due to the high rate of upstage rate to invasive disease.
目前对于接受乳房切除术治疗的导管原位癌（DCIS）的治疗指南推荐进行前哨淋巴结活检（SLNB）。在现代，存在尽量减少腋窝侵袭性分期和治疗的趋势。在本研究中，我们试图确定SLNB在接受乳房切除术治疗DCIS的患者中的作用。
从我们机构2012年至2016年的SLNB数据库中识别出接受乳房切除术的患者。如果粗针活检显示为DCIS，则纳入患者。提取患者的人口统计学、肿瘤特征和病理变量。
在2012年至2016年因DCIS或浸润性导管癌接受乳房切除术并行SLNB的187例患者中，39例（21%）粗针活检诊断为DCIS。平均年龄为57岁。70%为白种人，18%为非裔美国人，8%为亚洲人，其余5%未知。1例患者（3%）SLNB发现淋巴结阳性并接受了腋窝淋巴结清扫术。在粗针活检为DCIS的患者中，14例（36%）在最终手术病理检查中被上调为浸润性疾病，包括SLNB阳性的患者。在最终病理为DCIS的其余25例（64%）患者中，0例（0%）SLNB阳性。
接受乳房切除术的DCIS患者中仅3%被发现有前哨淋巴结转移。然而，相当数量的患者（36%）因浸润性癌而被上调分期。尽管样本量较小，但我们的结果表明，由于上调为浸润性疾病的比例较高，对于粗针活检为DCIS且接受乳房切除术的患者仍应推荐进行SLNB。
