- The likelihood of finding invasive cancer on final pathologic evaluation following a core needle biopsy showing DCIS:
- Has been reported to vary between 10% to 20%:
- Therefore, a second operation will be required in this subset of patients who are later found to have invasive cancer
- Has been reported to vary between 10% to 20%:
- NCCN guidelines recommend:
- Simultaneous performance of a sentinel lymph node biopsy when operating on patients with DCIS on core biopsy if:
- The index operation may compromise subsequent lymphatic drainage:
- Such as a mastectomy or a lumpectomy performed on a cancer in the axillary tail of the breast
- The index operation may compromise subsequent lymphatic drainage:
- Simultaneous performance of a sentinel lymph node biopsy when operating on patients with DCIS on core biopsy if:
- While pathologic subtypes of DCIS may be associated with higher risks of local recurrence:
- The presence of grade 3 disease and comedonecrosis:
- Are not associated with higher probabilities of nodal involvement
- The presence of grade 3 disease and comedonecrosis:
- Lastly, a history of prior invasive cancer is not associated with a higher probability of invasive cancer when the core biopsy demonstrated DCIS alone
- References
- Jakub JW, Murphy BL, Gonzalez AB, Conners AL, Henrichsen TL, Maimone S 4th, et al. A validated nomogram to predict upstaging of ductal carcinoma in situ to invasive disease. Ann Surg Oncol. 2017;24(10):2915-2924.
- NCCN guidelines Breast Cancer (version 1.2018). National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed October 18, 2019.
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Rodrigo Arrangoiz MS, MD, FACS, FSSO 