Role Of Sentinel Lymphadenectomy In Ductal Carcinoma In Situ

The number of patients diagnosed with ductal carcinoma in situ (DCIS) has increased dramatically over the last 20 years with the increased use of screening mammography. The treatment of DCIS has ranged from mastectomy to segmental resection. The role of axillary dissection has not been addressed in DCIS. The prognostic importance of axillary nodal metastases has focused on invasive cancer and, therefore, there has been no consensus as to the optimal management of the regional nodes in patients with noninvasive breast cancer.

Axillary nodal metastases have been documented in patients with DCIS. The American College of Surgeons Study reported a 1-4% incidence of nodal metastases [46]. In spite of this low rate of nodal metastases, data from the National Cancer Data Base in 1991 indicated that 58.5% of patients with DCIS underwent an axillary dissection [47]. Several investigators have used the lymphatic mapping technology to identify the sentinel node in patients with DCIS. Zavotsky and co-workers at the John Wayne Cancer Institute evaluated a subset of DCIS patients with evidence of microinvasion. Two patients (14.3%) had tumor-involved sentinel nodes. In both cases, the sentinel node was the only tumor involved node. Cox and co-workers reported a 4.6% incidence of nodal metastases in their cohort of 87 patients with DCIS [29].

Ductal carcinoma in situ has been classified into histological subtypes that correlate with biologic behavior. In situ comedo carcinoma carries a greater long-term risk for infiltrating cancer and is more likely to become invasive. Although the incidence of nodal metastases is low, sentinel lymphadenectomy appears to be a good alternative to axillary node dissection, particularly in comedo lesions. The use of systemic treatment has not been advocated in patients with DCIS in general. However, patients with nodal metastases would require adjuvant therapy, making sentinel lymphadenectomy an important diagnostic tool for these individuals.

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