Sá Rafael da Silva, Logullo Angela Flávia, Elias Simone, Facina Gil, Sanvido Vanessa Monteiro, Nazário Afonso Celso Pinto
Department of Gynaecology, Breast Surgery Team, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil.
Breast Cancer (Dove Med Press). 2021 Jun 21;13:409-417. doi: 10.2147/BCTT.S314447. eCollection 2021.
Mammography screening has become widely spread and provided a marked increase in ductal carcinoma in situ (DCIS) diagnosis. In DCIS, the ductal epithelium proliferates without invasion through the basal cell membrane. However, histologic underestimation can happen in some cases.
To analyze the rate of histologic underestimation (histopathologic results upgraded to invasive carcinoma after surgery) and the rate of positive results of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS in a Brazilian public hospital.
We reviewed medical records of all consecutive patients admitted between 2009 and 2013 whose initial diagnosis was DCIS through core needle biopsy. DCIS cases with a high risk of invasion underwent SLNB. We excluded cases with invasion or micro-invasion components in the first biopsy.
A total of 86 women were included, most with microcalcifications as the primary radiological lesion (73.2%), and underwent preoperative biopsy, with an invasive component in 21 (24.4%) in the final pathology report. Most had invasive carcinoma of no special type (NST): 52.3% (n = 11) and microinvasive tumors (7 cases, 33.3%). The main factors associated with histologic underestimation were nodular lesion (61.9%, p<0.001) and an ultra-sonography-guided biopsy (71.4%, p=0.0005). The positivity rate of SLNB was 4.3%. All these patients underwent mastectomy, and the initial histologic pattern was solid DCIS.
The "histologic underestimation" rate among patients with DCIS was not low, and less than 5% of patients who underwent SLNB had axillary positivity. This result suggests that patients who have DCIS and a high risk of invasion and undergoing mastectomy should have SLNB. As to the patients who will undergo lumpectomy, SLNB could be omitted and could be performed if patients have upgraded to invasive breast cancer.
乳腺钼靶筛查已广泛开展，导管原位癌（DCIS）的诊断率显著提高。在DCIS中，导管上皮细胞增生但未突破基底细胞膜。然而，在某些情况下可能会出现组织学低估。
分析巴西一家公立医院中被诊断为DCIS的患者的组织学低估率（手术后组织病理学结果升级为浸润性癌）和前哨淋巴结活检（SLNB）阳性率。
我们回顾了2009年至2013年间所有通过粗针活检初步诊断为DCIS的连续入院患者的病历。具有高侵袭风险的DCIS病例接受了SLNB。我们排除了首次活检中有浸润或微浸润成分的病例。
共纳入86名女性，大多数以微钙化为主要影像学病变（73.2%），并接受了术前活检，最终病理报告中有21例（24.4%）存在浸润成分。大多数为非特殊类型浸润性癌（NST）：52.3%（n = 11）和微浸润性肿瘤（7例，33.3%）。与组织学低估相关的主要因素是结节性病变（61.9%，p<0.001）和超声引导下活检（71.4%，p = 0.0005）。SLNB阳性率为4.3%。所有这些患者均接受了乳房切除术，初始组织学模式为实性DCIS。
DCIS患者的“组织学低估”率不低，接受SLNB的患者中腋窝阳性率不到5%。这一结果表明，患有DCIS且有高侵袭风险并接受乳房切除术的患者应进行SLNB。对于将接受保乳手术的患者，如果患者升级为浸润性乳腺癌，则可以省略SLNB，也可以进行SLNB。
