Abstract
Background
Sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) was controversial. Usually we did not do a SLN biopsy when we performed conserving operations with small-sized DCIS. However, sometimes we find DCIS with microinvasive breast cancer (MIC) after the operation. Must reoperations be performed in all patients? The incidence of axillary metastases in microinvasive breast cancer (MIC) has not been extensively studied. We determined the incidence of positive axillary lymph node (ALN) in patients with MIC and the predictive factors of ALN metastases in these patients.
Methods
Between July 1989 and December 2008, 9635 patients had operation on invasive breast cancer in Asan Medical Center. Among these patients, 319 patients had MIC. The research conducted on the 293 patients (excluded were 26 who did not receive axillary lymph node dissection or SLN biopsy). We retrospectively checked clinical and pathologic variables.
Results
There were 22 cases of ALN metastases identified in this group of patients (7.5%). Lymphatic invasion (P < .001) and positive estrogen receptor status (P = 03) were independent significant predictors of axillary metastases.
Conclusions
Microinvasive breast cancer is associated with a low rate of lymph node metastases. Some breast cancer patients with MIC at low likelihood of lymph node metastases may be spared lymph node evaluation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin. 2006;56:168–83.
Adamovich TL, Simmons RM. Ductal carcinoma in situ with microinvasion. Am J Surg. 2003;186:112–6.
Klauber-DeMore N, Tan LK, Liberman L, Kaptain S, Fey J, Borgen P, et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann Surg Oncol. 2000;7:636–42.
Cox CE, Nguyen K, Gray RJ, Salud C, Ku NN, Dupont E, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg. 2001;67:513–9; discussion 519–21.
Wong SL, Chao C, Edwards MJ, Carlson DJ, Laidley A, Noyes RD, et al. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg. 2002;184:492–8; discussion 498.
de Mascarel I, MacGrogan G, Mathoulin-Pelissier S, Soubeyran I, Picot V, Coindre JM. Breast ductal carcinoma in situ with microinvasion: a definition supported by a long-term study of 1248 serially sectioned ductal carcinomas. Cancer. 2002;94:2134–42.
Wasserberg N, Morgenstern S, Schachter J, Fenig E, Lelcuk S, Gutman H. Risk factors for lymph node metastases in breast ductal carcinoma in situ with minimal invasive component. Arch Surg. 2002;137:1249–52.
Intra M, Zurrida S, Maffini F, Sonzogni A, Trifirò G, Gennari R et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol. 2003;10:1160–5.
Yang M, Moriya T, Oguma M, De La Cruz C, Endoh M, Ishida T, et al. Microinvasive ductal carcinoma (T1mic) of the breast. The clinicopathological profile and immunohistochemical features of 28 cases. Pathol Int. 2003;53:422–8.
Gray RJ, Mulheron B, Pockaj BA, Degnim A, Smith SL. The optimal management of the axillae of patients with microinvasive breast cancer in the sentinel lymph node era. Am J Surg. 2007;194:845–8; discussion 848–9.
Fortunato L, Santoni M, Drago S, Gucciardo G, Farina M, Cesarini C, et al. Sentinel lymph node biopsy in women with pT1a or “microinvasive” breast cancer. Breast. 2008;17:395–400.
Sakr R, Barranger E, Antoine M, Prugnolle H, Daraï E, Uzan S. Ductal carcinoma in situ: value of sentinel lymph node biopsy. J Surg Oncol. 2006;94:426–30.
van la Parra RF, Ernst MF, Barneveld PC, Broekman JM, Rutten MJ, Bosscha K. The value of sentinel lymph node biopsy in ductal carcinoma in situ (DCIS) and DCIS with microinvasion of the breast. Eur J Surg Oncol. 2008;34:631–5.
Sakr R, Bezu C, Raoust I, Antoine M, Ettore F, Darcourt J, et al. The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes. Int J Clin Pract. 2008;62:1730–5.
Guth AA, Mercado C, Roses DF, Darvishian F, Singh B, Cangiarella JF. Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature. Breast J. 2008;14:335–9.
Zavagno G, Belardinelli V, Marconato R, Carcoforo P, Franchini Z, Scalco G, et al. Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion. Breast. 2007;16:146–51.
Wilkie C, White L, Dupont E, Cantor A, Cox CE. An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg. 2005;190:563–6.
Katz A, Gage I, Evans S, Shaffer M, Fleury T, Smith FP, et al. Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg. 2006;191:761–6.
Maffuz A, Barroso-Bravo S, Najera I, Zarco G, Alvarado-Cabrero I, Rodriguez-Cuevas SA. Tumor size as predictor of microinvasion, invasion, and axillary metastasis in ductal carcinoma in situ. J Exp Clin Cancer Res. 2006;25:223–7.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ko, B.S., Lim, W.S., Kim, H.J. et al. Risk Factor for Axillary Lymph Node Metastases in Microinvasive Breast Cancer. Ann Surg Oncol 19, 212–216 (2012). https://doi.org/10.1245/s10434-011-1812-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-1812-2