Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, 28644, Republic of Korea.
BMC Surg. 2021 Mar 22;21(1):159. doi: 10.1186/s12893-021-01170-x.
BACKGROUND: Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS). This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. METHODS: We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 2014 and 2018. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. RESULTS: The rate of upstaging to invasive cancer was 19.2% (59/307). DCIS diagnosed by core-needle biopsy (odds ratio [OR]: 6.861, 95% confidence interval [CI]: 2.429-19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224-6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197-8.323) were found to be associated with upstaging. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. CONCLUSIONS: In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy.
背景：由于导管原位癌（DCIS）的高升级率，前哨淋巴结活检（SLNB）经常不必要地进行。本研究旨在评估 DCIS 升级为浸润性癌的比例，确定腋窝淋巴结转移的患病率，并确定与升级和淋巴结转移相关的临床病理因素。我们还检查了 DCIS 患者的手术模式，并确定是否遵循了 SLNB 指南。
方法：我们回顾性分析了 2014 年至 2018 年间在单一中心通过术前活检诊断的 307 例连续 DCIS 患者。从临床记录中提取数据，包括影像学研究、腋窝和乳房手术类型以及术前和术后活检的病理结果。使用卡方检验和多因素逻辑回归分析进行单因素分析。
结果：升级为浸润性癌的比例为 19.2%（59/307）。与 SLNB 相关的因素包括：核心针活检诊断的 DCIS（比值比 [OR]：6.861，95%置信区间 [CI]：2.429-19.379）、超声团块形成病变（OR：2.782，95%CI：1.224-6.320）和孕激素受体阴性状态（OR：3.156，95%CI：1.197-8.323）。前哨淋巴结转移率仅为 1.9%（4/202），且均为核心针活检诊断的全乳房切除术患者。SLNB 分别在 145 例保乳手术患者（37.2%）和 162 例全乳房切除术患者（91.4%）中进行。在接受 SLNB 的 202 例患者中，145 例（71.7%）最终病理无浸润性癌患者存在冗余 SLNB。59 例（3.4%）疾病升级为浸润性癌的患者中，仅 2 例前哨淋巴结的初始分期不足，该比例似乎足够小。
结论：在术前诊断为 DCIS 的患者中，尽管存在不可避免的升级为浸润性癌的可能性，但发生腋窝转移的可能性不大。仅 2.7%的全乳房切除术患者存在前哨淋巴结转移。保乳手术患者不应该进行 SLNB，仅应保留核心针活检诊断的全乳房切除术患者。
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