Abstract
PurposeThe positivity of sentinel lymph node (SLN) metastasis is relatively low in ductal carcinoma in situ (DCIS) patients. The aim of this study was to investigate factors associated with SLN metastasis and build a model to predict the potential risk of SLN metastasis in patients with a preoperative diagnosis of DCIS.Patients and MethodsCore needle biopsy-proved DCIS patients who underwent SLN biopsy and breast surgery were retrospectively reviewed and selected. Univariate analysis was used to identify the variables correlated with SLN metastasis. A model to predict SLN metastasis was developed using a multivariate logistic regression in the training set and then validated in an internal set.ResultsA total of 407 patients with a preoperative diagnosis of DCIS were included. Upstaging to invasive/microinvasive cancer occurred in 225 patients after surgery. SLN metastasis was found in 42 patients, including 32 patients upstaging to invasive disease, 8 to microinvasive disease, and 2 pure DCIS. Tumor size based on US examination, axillary ultrasound finding, multifocality, surgery, upstaging, and Ki-67 expression were significantly related to SLN metastasis. The model incorporating tumor size, axillary ultrasound finding and multifocality yielded an AUC of 0.805 (95% CI: 0.715–0.895, p<0.001) in the training set, and 0.729 (95% CI: 0.547–0.911, p=0.013) in the testing set.ConclusionA simple model was developed to predict SLN metastasis in patients with a preoperative diagnosis of DCIS. With good discriminatory power, this model should be helpful for surgeons to decide if SLN biopsy could be safely avoided in certain patients.
Highlights
Breast cancer is the most frequently diagnosed cancer among females in China as in most other countries [1, 2]
Invasive disease was identified in 103 patients, and 122 cases were accompanied with microinvasive disease
sentinel lymph node (SLN) metastasis was found in 42 (10.3%) patients, among which macrometastasis alone and micrometastasis alone both presented in 20 patients, respectively
Summary
Breast cancer is the most frequently diagnosed cancer among females in China as in most other countries [1, 2]. DCIS undergoing mastectomy, in case when invasive disease is found in the surgical specimen, a second SLN procedure becomes mandatory but is no more possible [5]. In clinical practice, a substantial proportion of patients with a preoperative diagnosis of DCIS still undergo SLN biopsy during breast conserving surgery [6,7,8,9,10]. This discrepancy between guidelines and clinical practice may be largely attributed to the reluctance to return to the operating room when occult invasive disease is identified in the surgical specimen
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
