The American Society of Breast Surgeons
Do sentinel node micrometastases predict recurrence risk
in ductal carcinoma in situ and ductal carcinoma in situ
with microinvasion?
Colleen D. Murphy, M.D.
a,
*, Julie L. Jones, M.D.
b
, Sara Hughes Javid, M.D.
a
,
James S. Michaelson, Ph.D.
a
, Matthew E. Nolan, A.B.
a
, Stuart R. Lipsitz, Sc.D.
c
,
Michelle C. Specht, M.D.
a
, Beth-Ann Lesnikoski, M.D.
b
, Kevin S. Hughes, M.D.
a
,
Michele A. Gadd, M.D.
a
, Barbara L. Smith, M.D., Ph.D.
a
a
Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA;
b
Division of Surgical Oncology,
Brigham and Women’s Hospital, Boston, MA, USA;
c
Departments of Medicine and Surgery, Brigham and Women’s
Hospital, Boston, MA
Abstract
BACKGROUND: Because the implications of micrometastases found on sentinel node biopsy (SNB)
for ductal carcinoma in situ (DCIS) or ductal carcinoma in situ with microinvasion (DCISM) are largely
unknown, we wished to determine if SNB pathology predicted recurrence risk in DCIS/DCISM.
METHODS: Retrospective chart review identified patients with DCIS/DCISM who underwent SNB.
SNB findings and all local and distant recurrences were determined.
RESULTS: A total of 322 patients underwent SNB for DCIS/DCISM. There were 13 local recurrences
(4.0%) and 1 (.03%) distant recurrence at a median follow-up of 47.9 months (range 0 to 110.6), 12 in
patients with negative SNBs; 1 patient had a positive SNB. There were 4 recurrences after mastectomy and
9 after lumpectomy. In 29 patients with positive SNBs, there was only 1 recurrence (3.4%).
CONCLUSIONS: Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of
local or distant recurrence. Other features of DCIS and DCISM may be important in predicting recurrence risk.
© 2008 Elsevier Inc. All rights reserved.
KEYWORDS:
Breast neoplasm;
Ductal carcinoma
in situ;
Ductal carcinoma
in situ with
microinvasion;
Sentinel lymph
node biopsy;
Sentinel lymph node
micrometastases
Sentinel node biopsy (SNB) has been well validated for
staging invasive breast cancer with low rates of axillary
recurrence.
1
Some investigators have recommended routine
SNB for ductal carcinoma in situ (DCIS) or ductal carci-
noma in situ with microinvasion (DCISM) because 8% to
12% of these patients are found to have nodal metastases on
SNB
2
, and 10% to 20%
3
of patients with DCIS are upstaged
to invasive disease at definitive surgery. Because there are
little data on the long-term implications of such SNB me-
tastases, and because local recurrence rates for DCIS are
higher than for invasive disease, we wished to determine if
SNB pathology predicted local recurrence risk in patients
with DCIS or DCISM.
Patients and Methods
Institutional Review Board–approved chart review iden-
tified 322 patients with DCIS or DCISM on final pathology
who underwent SNB from 1997 to 2003. SNB was per-
* Corresponding author. Tel.: ϩ1-617-724-1074; fax: ϩ1-617-724-1079.
E-mail address: blsmith@partners.org
Manuscript received April 16, 2008; revised manuscript June 4, 2008
0002-9610/$ - see front matter © 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjsurg.2008.06.011
The American Journal of Surgery (2008) 196, 566–568