If the primary tumor was nonpalpable, we performed a new technique that we called radioguided occult lesion localization (ROLL) 14 to localize the tumor and the SLN using technetium Tc 99m macroaggregates. The skin projection of the lymph node was then marked and used as a landmark when beginning the dissection. Lymphoscintigraphy was then performed 15 to 30 minutes after injection and was repeated after 3 hours if no SLNs were evident in early images.Īnterior and anterior-oblique projections of the breast and axilla were obtained to determine the exact position of the SLN. 13 Briefly, 0.15 to 0.30 mCi (5-10 MBq) of technetium Tc 99m albumin colloid (20-80 nm) (Nanocol Nycomed Amersham-Sorin, Saluggia-VC, Italy) in 0.2 mL of isotonic sodium chloride solution was injected close to the tumor subdermally or peritumorally, the day before surgery or the same day. Lymphatic mapping was performed using a radiocolloid technique, as previously described. This study determines the prevalence of SLN metastases in a large series of patients with pure DCIS of the breast to determine the clinical usefulness of the SLN biopsy in these patients. 4, 11, 12 However, to our knowledge, the appropriateness of an SLN biopsy in the management of patients with pure DCIS of the breast has not been established thus far. The techniques of lymphatic mapping and SLN biopsy have also been applied in patients with DCIS, and have resulted in a similar increase in the detection rate of metastases in some series of patients with DCIS. Indeed, the examination of SLNs by serial sectioning and immunohistochemical reactions increases the detection rate of metastases from 9% to 33% in patients with an infiltrating carcinoma. In patients with invasive breast carcinoma, an SLN biopsy reduces the morbidity of axillary staging by minimizing lymphatic disruption 5 while increasing the accuracy of staging because it allows a thorough pathologic examination of the SLN. The sentinel lymph node (SLN) is the first node that receives lymphatic drainage from the primary tumor. Axillary dissection is not routinely indicated because of the low prevalence of nodal metastases, which is expected to be less than 2%, 4 and the significant morbidity associated with lymph node dissection. A total mastectomy can be required in cases of extensive intramammary spread. Standard treatment of DCIS is wide resection, with or without postoperative radiotherapy. Pure DCIS showed a 15-fold increase during the past 10 years, because of the widespread use of mammography for the detection of clinically nonpalpable tumors now, it accounts for 20% or more of mammographically detected carcinomas 1 - 3 and 12% of all newly diagnosed breast cancers. It usually presented as a palpable lesion, Paget disease, or bloody nipple discharge. PURE DUCTAL carcinoma in situ (DCIS) of the breast was infrequently diagnosed in the past, when it accounted for only 1% to 5% of all breast cancers. Complete axillary dissection may not be mandatory if the SLN is micrometastatic. It could be considered in patients with DCIS undergoing mastectomy, in whom there exists a higher risk of harboring an invasive component using definitive histologic features, like large solid tumors or diffuse or multicentric microcalcifications in these patients, an SLN biopsy cannot be performed at a later operation. In patients with pure DCIS in whom the lesion is completely excised by radical surgery, an SLN biopsy could be avoided. Of these 7 patients, 5 had only micrometastases in the SLNs and in the 6 patients treated with complete axillary dissection, the SLN was the only positive node.Ĭonclusions Because of the low prevalence of metastases, an SLN biopsy should not be considered a standard procedure in all patients with DCIS. Results Metastases in the SLN were detected in 7 (3.1%) of the 223 patients, and complete axillary dissection was subsequently performed in all these patients but 1. Patients From January 1, 1998, to December 1, 2001, 223 unselected consecutive patients affected by pure DCIS of the breast underwent an SLN biopsy. Setting Department of breast surgery of a comprehensive cancer center. Hypothesis A sentinel lymph node (SLN) biopsy should not be considered a standard procedure in the treatment of all patients with ductal carcinoma in situ (DCIS) of the breast if the lesion is completely excised by radical surgery and there are free margins of resection. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.
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