The Use of Sentinel Lymph Node Biopsy in Patients Undergoing Mastectomy for DCIS.

Publisher: Elsevier Country of Publication: United States NLM ID: 100898731 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-0666 (Electronic) Linking ISSN: 15268209 NLM ISO Abbreviation: Clin Breast Cancer Subsets: MEDLINE

Publication: 2011- : [New York] : Elsevier
Original Publication: Dallas, Tex. : Cancer Information Group

Sentinel Lymph Node Biopsy*/statistics & numerical data ; Carcinoma, Intraductal, Noninfiltrating*/surgery ; Carcinoma, Intraductal, Noninfiltrating*/pathology ; Breast Neoplasms*/pathology ; Breast Neoplasms*/surgery ; Mastectomy*/statistics & numerical data; Humans ; Female ; Middle Aged ; Retrospective Studies ; Aged ; Adult ; Lymphatic Metastasis/pathology ; Axilla

Background: Current guidelines do not recommend routine sentinel node biopsy (SLNB) for ductal carcinoma in situ (DCIS), except in the setting of mastectomy or microinvasive disease. This study aimed to evaluate national SLNB utilization in women undergoing upfront mastectomy for DCIS, identify predictors of SLNB utilization, and determine the percentage with a positive SLNB.
Methods: A retrospective cohort analysis was performed using the NCDB of women with clinical DCIS who underwent upfront mastectomy between 2012 and 2017. Demographic and clinicopathologic variables were compared between patients who underwent SLNB and those who did not. Multivariate logistic regression models were used to identify factors associated with SLNB utilization and positive SLNB.
Results: About 38,973 patients met inclusion criteria: 34,231 (88%) underwent SLNB and 4742 (12%) had no surgical axillary staging. Most patients were age 50-69 (51%), non-Hispanic White (71%), with private insurance (66%). On multivariate analysis, older patients were less likely to receive SLNB (P < .01), while patients with higher grade DCIS were more likely to undergo SLNB (P < .01). In those who underwent SLNB (n = 34,231), only 1,149 (3.4%) had nodal involvement. Non-Hispanic Black patients had increased odds of a positive SLNB (P < .01), while those with estrogen receptor positive disease were less likely to be node positive (OR 0.68, P < .001).
Conclusions: While 88% of patients had a SLNB, only 3.4% were found to be node positive. Given this low rate, it is reasonable to consider SLNB omission in select patients with low grade, hormone receptor positive DCIS undergoing upfront mastectomy.
Competing Interests: Disclosures All authors have no disclosures to report.
(Copyright © 2024 Elsevier Inc. All rights reserved.)

Ann Surg Oncol. 2022 Nov;29(12):7705-7712. (PMID: 35789303)
Ann Surg Oncol. 2006 Apr;13(4):491-500. (PMID: 16514477)
Cancer Epidemiol Biomarkers Prev. 2019 Aug;28(8):1316-1323. (PMID: 31186262)
J Breast Imaging. 2023 Oct 17;5(6):695-702. (PMID: 38046928)
Breast Cancer Res Treat. 2020 Sep;183(2):251-262. (PMID: 32651755)
Surg Clin North Am. 2023 Feb;103(1):121-139. (PMID: 36410345)
J Oncol Pract. 2011 Sep;7(5):309-13. (PMID: 22211128)
J Clin Oncol. 2017 Feb 10;35(5):561-564. (PMID: 27937089)
BMC Surg. 2017 Feb 7;17(1):12. (PMID: 28173790)
Ann Surg Oncol. 2017 Oct;24(10):2915-2924. (PMID: 28766196)
Ann Surg Oncol. 2023 Jul;30(7):4064-4072. (PMID: 36719570)
Br J Surg. 2024 Jan 31;111(2):. (PMID: 38325801)
JAMA Oncol. 2015 Jun;1(3):323-32. (PMID: 26181180)
Surgery. 2022 Mar;171(3):682-686. (PMID: 34736790)
Ann Surg Oncol. 2020 Sep;27(9):3448-3455. (PMID: 32232706)
J Clin Oncol. 2020 Oct 10;38(29):3430-3438. (PMID: 32730184)
BMC Surg. 2021 Mar 22;21(1):159. (PMID: 33752671)
Ann Surg Oncol. 2008 Jan;15(1):268-73. (PMID: 17891441)
J Clin Oncol. 2013 Jul 1;31(19):2382-7. (PMID: 23690420)
Breast J. 2020 May;26(5):931-936. (PMID: 31957944)
Front Oncol. 2020 Nov 10;10:590686. (PMID: 33304849)

K08 CA276706 United States CA NCI NIH HHS

Keywords: Axillary surgery; Breast cancer; DCIS; Ductal carcinoma in situ; SLNB

Date Created: 20240810 Date Completed: 20240915 Latest Revision: 20240917

20240917

PMC11402566

10.1016/j.clbc.2024.07.003

39127597