Annals of Surgical Oncology, Vol 7, Issue 1 15-20, Copyright © 2000 by Society of Surgical Oncology

ARTICLES

Sentinel node biopsy in ductal carcinoma in situ patients

S. Pendas, E. Dauway, R. Giuliano, N. Ku, C. E. Cox and D. S. Reintgen
Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center, University of South Florida, Tampa 33612-9497, USA.

BACKGROUND: Sentinel lymph node (SLN) mapping is an effective and accurate method of evaluating the regional lymph nodes in breast cancer patients. The SLN is the first node that receives lymphatic drainage from the primary tumor. Patients with micrometastatic disease, previously undetected by routine hematoxylin and eosin (H&E) stains, are now being detected with the new technology of SLN biopsy, followed by a more detailed examination of the SLN that includes serial sectioning and cytokeratin immunohistochemical (CK IHC) staining of the nodes. METHODS: At Moffitt Cancer Center, 87 patients with newly diagnosed pure ductal carcinoma in situ (DCIS) lesions were evaluated by using CK IHC staining of the SLN. Patients with any focus of microinvasive disease, detected on diagnostic breast biopsy by routine H&E, were excluded from this study. DCIS patients, with biopsy-proven in situ tumor by routine H&E stains, underwent intraoperative lymphatic mapping, using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised SLNs were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. All SLNs that had only CK-positive cells were subsequently confirmed malignant by a more detailed histological examination of the nodes. RESULTS: CK IHC staining was performed on 177 SLNs in 87 DCIS breast cancer patients. Five of the 87 DCIS patients (6%) had positive SLNs. Three of these patients were only CK positive and two were both H&E and CK positive. Therefore, routine H&E staining missed microinvasive disease in three of five DCIS patients with positive SLNs. In addition, DCIS patients with occult micrometastatic disease to the SLN underwent a complete axillary lymph node dissection, and the SLNs were the only nodes found to have metastatic disease. Of interest, four of the five node-positive patients had comedo carcinoma associated with the DCIS lesion, and one patient had a large 9.5-cm low grade cribriform and micropapillary type of DCIS. CONCLUSIONS: This study confirms that lymphatic mapping in breast cancer patients with DCIS lesions is a technically feasible and a highly accurate method of staging patients with undetected micrometastatic disease to the regional lymphatic basin. This procedure can be performed with minimal morbidity, because only one or two SLNs, which are at highest risk for containing metastatic disease, are removed. This allows the pathologist to examine the one or two lymph nodes with greater detail by using serial sectioning and CK IHC staining of the SLNs. Because most patients with DCIS lesions detected by routine H&E stains do not have regional lymph node metastases, these patients can safely avoid the complications associated with a complete axillary lymph node dissection and systemic chemotherapy. However, DCIS patients with occult micrometastases of the regional lymphatic basin can be staged with higher accuracy and treated in a more selective fashion.

This article has been cited by other articles:

				E. J.T. Rutgers Sentinel Node Biopsy: Interpretation and Management of Patients With Immunohistochemistry-Positive Sentinel Nodes and Those With Micrometastases J. Clin. Oncol., February 10, 2008; 26(5): 698 - 702. [Abstract] [Full Text] [PDF]

				F. J. Dominguez, M. Golshan, D. M. Black, K. S. Hughes, M. A. Gadd, R. Christian, B.-A. Lesnikoski, M. Specht, J. Michaelson, and B. L. Smith Sentinel Node Biopsy is Important in Mastectomy for Ductal Carcinoma In Situ Ann. Surg. Oncol., January 1, 2008; 15(1): 268 - 273. [Abstract] [Full Text] [PDF]

				K. H. Moore, K. J. Sweeney, M. E. Wilson, J. I. Goldberg, C. L. Buchanan, L. K. Tan, L. Liberman, R. R. Turner, M. D. Lagios, H. S. Cody III, et al. Outcomes for Women With Ductal Carcinoma-in-Situ and a Positive Sentinel Node: A Multi-Institutional Audit Ann. Surg. Oncol., October 1, 2007; 14(10): 2911 - 2917. [Abstract] [Full Text] [PDF]

				H. S. Cody III Sentinel Lymph Node Biopsy for DCIS: Are We Approaching Consensus? Ann. Surg. Oncol., August 1, 2007; 14(8): 2179 - 2181. [Full Text] [PDF]

				T. B. Julian, S. R. Land, V. Fourchotte, S. R. Haile, E. R. Fisher, E. P. Mamounas, J. P. Costantino, and N. Wolmark Is Sentinel Node Biopsy Necessary in Conservatively Treated DCIS? Ann. Surg. Oncol., August 1, 2007; 14(8): 2202 - 2208. [Abstract] [Full Text] [PDF]

				J. C. C. Tan, D. R. McCready, A. M. Easson, and W. L. Leong Role of Sentinel Lymph Node Biopsy in Ductal Carcinoma-in-situ Treated by Mastectomy Ann. Surg. Oncol., February 1, 2007; 14(2): 638 - 645. [Abstract] [Full Text] [PDF]

				S. L. Chen, D. M. Iddings, R. P. Scheri, and A. J. Bilchik Lymphatic Mapping and Sentinel Node Analysis: Current Concepts and Applications CA Cancer J Clin, September 1, 2006; 56(5): 292 - 309. [Abstract] [Full Text] [PDF]

				I. J. Bleiweiss, C. S. Nagi, and S. Jaffer Axillary Sentinel Lymph Nodes Can Be Falsely Positive Due to Iatrogenic Displacement and Transport of Benign Epithelial Cells in Patients With Breast Carcinoma J. Clin. Oncol., May 1, 2006; 24(13): 2013 - 2018. [Abstract] [Full Text] [PDF]

				H. M. Kuerer and L. A. Newman Lymphatic Mapping and Sentinel Lymph Node Biopsy for Breast Cancer: Developments and Resolving Controversies J. Clin. Oncol., March 10, 2005; 23(8): 1698 - 1705. [Full Text] [PDF]

				M. El-Tamer, J. Chun, M. Gill, D. Bassi, S. Lee, H. Hibshoosh, and M. Mansukhani Incidence and Clinical Significance of Lymph Node Metastasis Detected by Cytokeratin Immunohistochemical Staining in Ductal Carcinoma In Situ Ann. Surg. Oncol., March 1, 2005; 12(3): 254 - 259. [Abstract] [Full Text] [PDF]

				H. J. Burstein, K. Polyak, J. S. Wong, S. C. Lester, and C. M. Kaelin Ductal Carcinoma in Situ of the Breast N. Engl. J. Med., April 1, 2004; 350(14): 1430 - 1441. [Full Text] [PDF]

				M. Intra, S. Zurrida, F. Maffini, A. Sonzogni, G. Trifiro, R. Gennari, P. Arnone, G. Bassani, A. Opazo, G. Paganelli, et al. Sentinel Lymph Node Metastasis in Microinvasive Breast Cancer Ann. Surg. Oncol., December 1, 2003; 10(10): 1160 - 1165. [Abstract] [Full Text] [PDF]

				M. Intra, P. Veronesi, G. Mazzarol, V. Galimberti, A. Luini, V. Sacchini, G. Trifiro, O. Gentilini, G. Pruneri, P. Naninato, et al. Axillary Sentinel Lymph Node Biopsy in Patients With Pure Ductal Carcinoma In Situ of the Breast Arch Surg, March 1, 2003; 138(3): 309 - 313. [Abstract] [Full Text] [PDF]

				R. Tamhane, J. E. Dahlstrom, D. D. McCallum, and J. M. Buckingham The Clinical Significance of Cytokeratin-Positive Cells in Lymph Nodes at the Time of Mastectomy From Patients With Ductal Carcinoma-In-Situ Ann. Surg. Oncol., December 1, 2002; 9(10): 999 - 1003. [Abstract] [Full Text] [PDF]

				J. Bonnema and C. J. H. van de Velde Sentinel lymph node biopsy in breast cancer Ann. Onc., October 1, 2002; 13(10): 1531 - 1537. [Abstract] [Full Text] [PDF]

				M. Morrow, E. A. Strom, L. W. Bassett, D. D. Dershaw, B. Fowble, J. R. Harris, F. O'Malley, S. J. Schnitt, S. E. Singletary, and D. P. Winchester Standard for the Management of Ductal Carcinoma In Situ of the Breast (DCIS) CA Cancer J Clin, September 1, 2002; 52(5): 256 - 276. [Abstract] [Full Text] [PDF]

				H. S. Cody III, N. Klauber-DeMore, P. I. Borgen, and K. J. Van Zee Is It Really Duct Carcinoma In Situ? Ann. Surg. Oncol., September 1, 2001; 8(8): 617 - 619. [Full Text] [PDF]

				K. Dowlatshahi, M. Fan, J. M. Anderson, and K. J. Bloom Occult Metastases in Sentinel Nodes of 200 Patients With Operable Breast Cancer Ann. Surg. Oncol., September 1, 2001; 8(8): 675 - 681. [Abstract] [Full Text] [PDF]

				L. L. Tuthill, H. E. Reynolds, and R. J. Goulet Jr. Biopsy of Sentinel Lymph Nodes Guided by Lymphoscintigraphic Mapping in Patients with Breast Cancer Am. J. Roentgenol., February 1, 2001; 176(2): 407 - 411. [Abstract] [Full Text] [PDF]