Factors Predicting Microinvasion in Ductal Carcinoma in situ

Sibel Ozkan-Gurdal,Mahmut Muslumanoglu,Beyza Ozcinar,Mustafa Kecer,Abdullah Igci,Ekrem Yavuz,Vahit Ozmen,Neslihan Cabioglu

doi:10.7314/apjcp.2014.15.1.55

Sibel Ozkan-Gurdal, Mahmut Muslumanoglu + Show 6 more

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https://doi.org/10.7314/apjcp.2014.15.1.55

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Journal: Asian Pacific Journal of Cancer Prevention	Publication Date: Jan 15, 2014
Citations: 38	License type: cc-by

Abstract

Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95%CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS.

Highlights

Ductal carcinoma in situ (DCIS) of the breast is a noninvasive or preinvasive lesion characterized by malignant ductal cells confined to the duct lumen, without evidence of invasion into the adjacent breast stroma
Our findings suggest patients presenting with a preoperative diagnosis of ductal carcinoma in situ (DCIS) associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for sentinel lymph node biopsy (SLNB) procedure along with patients who will undergo mastectomy due to DCIS
In a previous population-based study, only 1.9% of patients with DCIS died of breast cancer within 10 years of their diagnosis (Greenlee et al, 2001)

Summary

Introduction

Ductal carcinoma in situ (DCIS) of the breast is a noninvasive or preinvasive lesion characterized by malignant ductal cells confined to the duct lumen, without evidence of invasion into the adjacent breast stroma. It is known that some women treated for DCIS subsequently develop invasive breast cancer, which is associated with a poorer prognosis. Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS

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