Sentinel Lymph Node Biopsy in Ductal Carcinoma In Situ (DCIS)

  • DCIS is noninvasive:
    • By definition, is unable to metastasize:
      • However, studies have shown that up to 15% of patients with pure DCIS:
        • Have isolated tumor cells (ITCs) or micrometastasis on nodal evaluation
      • However, these small tumor deposits:
        • Likely have little prognostic significance:
          • They may represent only cell clusters displaced by biopsy
  • In patients with DCIS detected by core biopsy:
    • There is a 15% to 20% associated risk:
      • Of an invasive component when excised
  • Patients undergoing mastectomy for DCIS:
    • Should be offered SLNB:
      • Since it would not be feasible to perform following mastectomy:
        • If invasive carcinoma is subsequently identified
  • ASCO consensus guidelines recommend that:
    • Patients with DCIS who undergo breast-conserving operation should not routinely have SLNB:
      • However, SLNB could be discussed with patients undergoing breast conservation:
        • Who have a core biopsy diagnosis of DCIS and:
          • A large area of DCIS on imaging (2 cm to 5 cm)
          • High-grade DCIS
          • Comedonecrosis
          • When a physical examination or imaging:
            • Shows a discrete mass
      • These findings have been associated with an increased risk of invasive cancer:
        • And SLNB at the time of the initial operation could avoid a second operation

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #Surgeon #Teacher #BreastCancer #BreastDiseases #AxillaryDissection #BreastSurgery #MountSinaiMedicalCenter #MSMC #Miami #Mexico #SLNM #SLNB #SentinelLymphNodeBiopsy

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