This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core‐needle biopsy. BJS 2007; 94: 952-956.
Published: 17th April 2007
Authors: P. Meijnen, H. S. A. Oldenburg, C. E. Loo, O. E. Nieweg, J. L. Peterse, E. J. T. Rutgers et al.
Background
The aim of the study was to assess the risk of invasion and axillary lymph node metastasis in patients with ductal carcinoma in situ (DCIS) diagnosed by preoperative core‐needle biopsy. The data were used to select criteria for patients in whom sentinel node (SN) biopsy might be indicated.
Method
One hundred and seventy‐one women with 172 DCIS lesions diagnosed by core‐needle biopsy were analysed. Axillary staging was performed by SN biopsy, axillary node sampling, or level 1–2 axillary lymph node dissection.
Results
Invasive breast cancer was found in the surgical specimens from 45 tumours (26·2 per cent). Risk factors for invasion were a palpable lesion (odds ratio (OR) 2·95 (95 per cent confidence interval 1·20 to 7·26); P = 0·019), presence of a mass on mammography (OR 3·06 (1·43 to 6·56); P = 0·004), and intermediate (OR 5·81 (1·18 to 28·57); P = 0·030) or poorly differentiated (OR 5·46 (1·17 to 25·64); P = 0·031) tumour grade. Lymph node metastases were found in ten women with DCIS and invasion on final pathology. Factors associated with metastases were age 55 years or less (P = 0·030), invasion of 1·0 cm or more (P < 0·001) and the presence of vascular invasion (P = 0·001).
Conclusion
SN biopsy should be considered in women with an initial diagnosis of DCIS on core‐needle biopsy who are at risk for invasion; this includes women with a palpable lump, a mass on mammography, and intermediate or poor tumour grade. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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