Ramos Marcellus do Nascimento Moreira, Mattar André, Antonini Marcelo, Zerwes Felipe, Cavagna Felipe, Cavalcante Francisco Pimentel, Millen Eduardo Camargo, Brenelli Fabricio Palermo, Luiz Frasson Antonio, Madeira Marcelo, Amorim Andressa Gonçalves, Teixeira Marina Diógenes, de Figueiredo Marina Fleury, de Oliveira Larissa Chrispim, Sorares Leonardo Ribeiro, Facina Gil, Fenile Rogerio, de Freitas Júnior Ruffo, Arakelian Renata, Dos Santos Marcela Bonalumi, Couto Henrique Lima, Leite Renata Montarroyos, Gomes Pedro Paulo de Andrade, Gomes Gabriela de Oliveira, Gebrim Luiz Henrique, Lopes Reginaldo Guedes Coelho, Real Juliana Monte
Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, Brazil.
Centro de Referência da Saúde da Mulher - Hospital da Mulher, São Paulo, Brazil.
World J Surg Oncol. 2025 Jul 12;23(1):275. doi: 10.1186/s12957-025-03926-8.
The role of axillary surgery in ductal carcinoma in situ (DCIS) remains controversial, particularly for cases diagnosed via vacuum-assisted biopsy (VAB), which may reduce "upstage" to invasive disease. This study evaluates the incidence of axillary metastasis and pathologic upstaging in DCIS to identify subgroups where axillary staging can be safely omitted.
A retrospective cohort of 494 patients with pure DCIS diagnosed by VAB (2011-2019) was analyzed. Patients were stratified by age, nuclear grade, comedonecrosis, and surgical approach (breast-conserving surgery [BCS] vs. mastectomy). Axillary management included sentinel node biopsy (SNB), axillary dissection (AD), or omission. Multivariate logistic regression identified predictors of axillary surgery and upstaging to invasive carcinoma.
Most patients underwent BCS (72.7%), with axillary evaluation performed in 35.1% of BCS cases versus 91.9% of mastectomies (p < 0.001). Only 3.8% (19/494) were upstaged to invasive carcinoma, and nodal involvement occurred in 1.2% (3/250) of axillary procedures-all in patients with invasive foci on final pathology. No pure DCIS cases had nodal metastasis. Younger age (< 40 years, p = 0.039), high nuclear grade (grade 3, p = 0.006), and mastectomy (p < 0.001) independently predicted axillary surgery. Comedonecrosis and palpable lesions were associated with higher SNB rates but not nodal positivity.
Routine axillary surgery is unnecessary in VAB-diagnosed DCIS. Omission of SNB appears safe for patients undergoing BCS without high-risk features (palpability, high grade). Axillary staging may be reserved for mastectomy candidates or those with suspicions imaging of invasive disease.
腋窝手术在导管原位癌（DCIS）中的作用仍存在争议，特别是对于通过真空辅助活检（VAB）诊断的病例，这可能会减少“升级”为浸润性疾病的情况。本研究评估DCIS中腋窝转移和病理分期升级的发生率，以确定可以安全省略腋窝分期的亚组。
分析了一组回顾性队列，共494例经VAB诊断为纯DCIS的患者（2011 - 2019年）。患者按年龄、核分级、粉刺样坏死和手术方式（保乳手术[BCS]与乳房切除术）进行分层。腋窝处理包括前哨淋巴结活检（SNB）、腋窝清扫（AD）或省略。多因素逻辑回归确定腋窝手术和升级为浸润性癌的预测因素。
大多数患者接受了BCS（72.7%），35.1%的BCS病例进行了腋窝评估，而乳房切除术病例的这一比例为91.9%（p < 0.001）。仅3.8%（19/494）升级为浸润性癌，腋窝手术中1.2%（3/250）出现淋巴结受累，所有这些患者最终病理均有浸润灶。无纯DCIS病例发生淋巴结转移。年龄较小（< 40岁，p = 0.039）、核分级高（3级，p = 0.006）和乳房切除术（p < 0.001）独立预测腋窝手术。粉刺样坏死和可触及病变与较高的SNB率相关，但与淋巴结阳性无关。
在VAB诊断的DCIS中，常规腋窝手术不必要。对于没有高危特征（可触及、高级别）的接受BCS的患者，省略SNB似乎是安全的。腋窝分期可保留给乳房切除术候选者或那些怀疑有浸润性疾病影像学表现的患者。
