Skip to main content
SSO 2024 Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded for On-Demand Viewing
Recorded for On-Demand Viewing
Back

Breast

E56: Can sentinel lymph node biopsy be safely avoided in women undergoing mastectomy for DCIS?

Introduction: Ductal carcinoma in situ (DCIS) identified on core needle biopsy is upgraded to invasive breast carcinoma (IBC) on definitive surgical excision at a rate of 15-50%. Sentinel lymph node (SLN) mapping is not readily feasible after mastectomy, thus axillary dissection could be required if DCIS treated with mastectomy is upgraded on final pathology. To avoid this, current recommendations suggest the addition of ipsilateral SLN biopsy for preemptive axillary staging at the time of mastectomy when performed for DCIS. With the advent of genomic assays in addition to data supporting avoidance of axillary investigation in older women with favorable cancers, the clinical relevance of SLN biopsy in this setting is in question. This study aimed to determine the rate of upstaging to IBC and the nodal tumor burden in patients undergoing mastectomy for pure DCIS.

Methods: This is a single-intuition, 20-year retrospective review of women aged 50 and over undergoing mastectomy as primary surgical therapy for a preoperative diagnosis of pure DCIS and clinically negative lymph nodes. We determined the rate of upstaging from DCIS to IBC on final pathology and the rate of metastatic nodal disease identified by SLN biopsy at the time of mastectomy.  

Results: From the CCHS tumor registry, we identified 87 patients who met study criteria treated from 2000-2020. Of those, 13 (14.94%) were upstaged to IBC. Among those upstaged, only 2 patients (15% of those upstaged or 2.3% of the total population) had SLNs positive for metastatic carcinoma, leaving 97.7% of the patients in the study with negative lymph nodes.

Conclusions: With the current trend in the management of breast malignancy toward de-escalation of axillary surgery, the management of those with DCIS undergoing mastectomy should be reconsidered. Our research found that although we had an upstaging rate to IBC consistent with that in the current literature, the vast majority of patients in our study had negative SLNs (97.7%) and addition of SLN biopsy to mastectomy for pure DCIS had no bearing on adjuvant therapy recommendations. As we continue to pursue shared decision-making with our patients, we should take into consideration the potential adverse effects of axillary surgery and the role it will play in patients' overall treatment recommendations.

Learning Objectives:

  • Discuss surgical management of ductal carcinoma in situ
  • Define upgrade rates of DCIS to invasive cancer
  • Discuss trends in axillary nodal staging