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Axillary Node Staging for Microinvasive Breast Cancer: Is It Justified?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The natural history and role of axillary staging in microinvasive breast cancer (DCISM) remains controversial. We report clinical characteristics and outcome in patients with DCISM, focusing on the role of sentinel lymph node (SLN) biopsy.

Methods

From our prospective database we retrospectively identified 112 patients with DCISM who underwent SLN biopsy between 1996 and 2004 at our institution. Median follow-up was 6 years.

Results

We found positive SLN in 12 % of patients (14 of 112): macrometastasis in 2.7 % (3 of 112) and micrometastases or isolated tumor cells (ITC) in 10 % (11 of 112). We performed axillary dissection (ALND) in all patients with macrometastasis (3 of 3), finding additional positive nodes in 66 % (2 of 3), and in 27 % of those with micrometastases/ITCs (3 of 11), finding no additional positive nodes. Among 98 patients with negative SLN (38 % of whom received systemic therapy), there were 5 locoregional recurrences (1 in the ipsilateral axilla, 4 in the ipsilateral breast, all DCIS) and 4 contralateral second primary cancers. Among 14 patients with positive SLN (82 % of whom received systemic adjuvant therapy), there were no locoregional or distant recurrences.

Conclusions

Our results suggest that SLN biopsy may be justified for DCISM, but is clearly most beneficial to identify a very small subset of DCISM patients (2.7 %, with SLN macrometastasis) who could benefit from systemic adjuvant therapy. The benefit of SLN biopsy for patients with SLN micrometastases/ITCs (pN0mi or pN0(i+)) is uncertain, and in these cases ALND does not appear to be warranted. We suggest a wider reappraisal of routine SLN biopsy for DCISM.

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References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Harris JR. Diseases of the Breast. Philadelphia: Lippincott Williams & Wilkins, 2010.

    Google Scholar 

  3. Camp R, Feezor R, Kasraeian A, Cendan J, Schell S, Wilkinson E, et al. Sentinel lymph node biopsy for ductal carcinoma in situ: an evolving approach at the University of Florida. Breast J. 2005;11:394–7.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  CAS  Google Scholar 

  9. Parikh RR, Haffty BG, Lannin D, Moran MS. Ductal carcinoma in situ with microinvasion: prognostic implications, long-term outcomes, and role of axillary evaluation. Int J Radiat Oncol Biol Phys. 2010;82:7–13.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Vieira CC, Mercado CL, Cangiarella JF, Moy L, Toth HK, Guth AA. Microinvasive ductal carcinoma in situ: clinical presentation, imaging features, pathologic findings, and outcome. Eur J Radiol. 2010;73:102–7.

    Article  PubMed  Google Scholar 

  12. Wong JH, Kopald KH, Morton DL. The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer. Arch Surg. 1990;125:1298–301 (discussion 1301–2).

    Article  PubMed  CAS  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Moore KH, Sweeney KJ, Wilson ME, Goldberg JI, Buchanan CL, Tan LK, et al. Outcomes for women with ductal carcinoma-in-situ and a positive sentinel node: a multi-institutional audit. Ann Surg Oncol. 2007;14:2911–7.

    Article  PubMed  Google Scholar 

  15. 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).

    Article  PubMed  Google Scholar 

  16. Zavotsky J, Hansen N, Brennan MB, Turner RR, Giuliano AE. Lymph node metastasis from ductal carcinoma in situ with microinvasion. Cancer. 1999;85:2439–43.

    Article  PubMed  CAS  Google Scholar 

  17. Wasserberg N, Morgenstern S, Schachter, 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.

    Article  PubMed  Google Scholar 

  18. AJCC Cancer Staging Handbook. New York: Springer; 2009.

  19. Hill AD, Tran KN, Akhurst T, Yeung H, Yeh SD, Rosen PP, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg. 1999;229:528–35.

    Article  PubMed  CAS  Google Scholar 

  20. Cody HS, 3rd, Borgen PI. State-of-the-art approaches to sentinel node biopsy for breast cancer: study design, patient selection, technique, and quality control at Memorial Sloan-Kettering Cancer Center. Surg Oncol. 1999;8:85–91.

    Article  PubMed  Google Scholar 

  21. Hoda SA, Chiu A, Prasad ML, Giri D, Hoda RS. Are microinvasion and micrometastasis in breast cancer mountains or molehills? Am J Surg. 2000;180:305–8.

    Article  PubMed  CAS  Google Scholar 

  22. Bianchi S, Vezzosi V. Microinvasive carcinoma of the breast. Pathol Oncol Res. 2008;14:105–11.

    Article  PubMed  Google Scholar 

  23. Schuh ME, Nemoto T, Penetrante RB, Rosner D, Dao TL. Intraductal carcinoma. Analysis of presentation, pathologic findings, and outcome of disease. Arch Surg. 1986;121:1303–7.

    Article  PubMed  CAS  Google Scholar 

  24. Rosner D, Lane WW, Penetrante R. Ductal carcinoma in situ with microinvasion. A curable entity using surgery alone without need for adjuvant therapy. Cancer. 1991;67:1498–503.

    Article  PubMed  CAS  Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. Silver SA, Tavassoli FA. Mammary ductal carcinoma in situ with microinvasion. Cancer. 1998;82:2382–90.

    Article  PubMed  CAS  Google Scholar 

  27. Mann GB, Port ER, Rizza C, Tan LK, Borgen PI, Van Zee KJ. Six-year follow-up of patients with microinvasive, T1a, and T1b breast carcinoma. Ann Surg Oncol. 1999;6:591–8.

    Article  PubMed  CAS  Google Scholar 

  28. Solin LJ, Fowble BL, Yeh IT, Kowalyshyn MJ, Schultz DJ, Weiss MC, et al. Microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation. Int J Radiat Oncol Biol Phys. 1992;23:961–968.

    Article  PubMed  CAS  Google Scholar 

  29. Dowlatshahi K, Fan M, Snider HC, Habib FA. Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer. 1997;80:1188–97.

    Article  PubMed  CAS  Google Scholar 

  30. Tan LK, Giri D, Hummer AJ, Panageas KS, Brogi E, Norton L, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up. J Clin Oncol. 2008;26:1803–9.

    Article  PubMed  Google Scholar 

  31. de Boer M, van Deurzen CH, van Dijck JA, Borm GF, van Diest PJ, Adang EM, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009;361:653–63.

    Article  PubMed  Google Scholar 

  32. Giuliano AE, Hawes D, Ballman KV, Whitworth PW, Blumencranz PW, Reintgen DS, et al. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. JAMA. 2011;306:385–93.

    Article  PubMed  CAS  Google Scholar 

  33. Weaver DL, Ashikaga T, Krag DN, Skelly JM, Anderson SJ, Harlow SP, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21.

    Article  PubMed  CAS  Google Scholar 

  34. Julian TB AS, Golesorkhi N, Fourchotte V, Mamounas EP, Wolmark N. Prospective outcomes for patients with micrometastases and macrometastases in sentinel nodes: NSABP B-32 sentinel node trial. Oral presentation. Cancer Res. 2010;70(24 Suppl):Abstract nr S5-1.

    Google Scholar 

  35. Murphy CD, Jones JL, Javid SH, Michaelson JS, Nolan ME, Lipsitz SR, et al. Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion? Am J Surg. 2008;196:566–8.

    Article  PubMed  Google Scholar 

  36. Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32; discussion 432–3.

    PubMed  Google Scholar 

  37. Pugliese M, Stempel M, Patil S, Hsu M, Ho A, Traina T, et al. The clinical impact and outcomes of immunohistochemistry-only metastasis in breast cancer. Am J Surg. 2010;200:368–73.

    Article  PubMed  Google Scholar 

  38. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.

    Article  Google Scholar 

  39. Pimiento JM, Lee MC, Esposito NN, Kiluk JV, Khakpour N, Carter B, et al. Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Pract. 2011;7:309–13.

    Article  PubMed  Google Scholar 

  40. Ko BS, Lim WS, Kim HJ, Yu JH, Lee JW, Kwan SB, et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer. Ann Surg Oncol. 2012;19:212–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    John M. Lyons III MD, Michelle Stempel MPH, Kimberly J. Van Zee MS, MD, FACS & Hiram S. Cody III MD, FACS

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  1. John M. Lyons III MD
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  2. Michelle Stempel MPH
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  3. Kimberly J. Van Zee MS, MD, FACS
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  4. Hiram S. Cody III MD, FACS
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Correspondence to John M. Lyons III MD.

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Lyons, J.M., Stempel, M., Van Zee, K.J. et al. Axillary Node Staging for Microinvasive Breast Cancer: Is It Justified?. Ann Surg Oncol 19, 3416–3421 (2012). https://doi.org/10.1245/s10434-012-2376-5

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  • DOI: https://doi.org/10.1245/s10434-012-2376-5

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