![]() ![]() American Joint Cancer Committee/Union Internationale Contre le Cancer, 2009), and the recommendations of AFIP (DCIS) and Elston Ellis (IDC) were used to evaluate tumor grade. The World Health Organization criteria were used to classify tumor histology and nodal status (tumor, noes, and metastasis classification VII ed. The samples with a maximum diameter of 30 mm or less were completely sliced and examined, while for larger specimens, the sampling method followed the European guidelines. We excluded all histotypes other than ductal carcinoma, male breast cancer, and tumors sized >2 cm by radiological diagnosis or microscopical evaluation.Ĭollected data included patient characteristics (age at diagnosis, body mass index, positive family history for breast or ovarian cancer, fertility status, eventual use of estroprogestinic therapies), tumor characteristics (histotype, grading, expression of estrogen receptor (ER), progesterone receptor (PR), HER2/neu expression, and Mib1/Ki-67, multifocality/multicentricity, peritumoral vascular invasion (PVI), peritumoral inflammation, nodal extracapsular invasion or bunched axillary nodes ), surgical and non surgical management.Įuropean guidelines were followed to routinely assess the pathological specimens. The study was designed according to the dictates of the general authorization to process personal data for scientific research purposes by the Italian Data Protection Authority. In particular, in this study, we evaluated the prevalence of sentinel node metastasis and their clinical role by SLNB performed in women affected by DCIS, as well as their influence on patient outcome in terms of overall survival (OS) and disease-free survival (DFS).įor this chart review study, we collected retrospective data about all consecutive women operated on their breast for DCIS or invasive ductal carcinoma (IDC) sized ≤2 cm (pT1) in our Department between January 2002 and June 2016. Ĭonsidering the controversy around pathogenesis and management of axillary metastases in DCIS, we reviewed our experience with sentinel lymph node biopsy (SLNB) among patients with DCIS. However, microinvasive foci are shown to be very difficult to detect especially in the case of very wide intraductal carcinoma. Some authors have described a prevalence of even 58.3% of occult invasion by histological re-examination of specimens of patients affected by DCIS with nodal metastasis, and thus significantly higher than that of specimens of pTisN0 patients. Microinvasion is defined as the extension of cancer cells beyond the basal membrane into the adjacent tissues, sized ≤1 mm, but a recent study hypothesized that tumor cell dissemination may also occur before stroma invasion. Nodal involvement in DCIS likely depends on the misdetection of occult microscopic invasive foci (occult microinvasion) due to technical limitations in specimen pathological assessment. Even in the absence of an evident invasive component, microinvasion should always be suspected in these cases, and their management should be the same as for IDC.Īlthough usually in situ cancer should not be able to shed neoplastic cells into the bloodstream or infiltrate the lymphatic net, there is a variable reported percentage of ductal carcinoma in situ (DCIS) which present an axillary nodal involvement, with higher rates noted in the premammographic era. Our study suggests that despite its rarity, sentinel node metastasis may also occur in case of DCIS, which in most cases are micrometastases. Predictors for the microinvasive component in DCIS were tumor multifocality/multicentricity, grading ≥2, ITCs and micrometastases. Significant predictors for distant metastases were DCISM, IDC, macroscopic nodal metastasis, and tumor grading ≥2. IDC, tumor grading ≥2 and lymph node (LN) macrometastasis were significant predictors for decreased overall survival. 5-year local recurrence rate of DCIS and DCISM were respectively 2.5% and 7.9%, and their 5-year distant recurrence rate respectively 0% and 4%. 5-year disease-free survival and overall survival in DCISM and IDC were similar, while significantly longer in DCIS. ![]() In cases of DCIS and DCISM, SLNB resulted micrometastatic respectively in 1.7% and 6.0% of cases and macrometastatic respectively in 0.9% and 3.6% of cases. We collected retrospective data on patients operated on their breasts for DCIS (pTis), DCIS with microinvasion (DCISM) (pT1mi) and invasive ductal carcinoma (IDC) sized ≤2 cm (pT1) between January 2002 and June 2016, focusing on the result of SLNB.ĥ43 DCIS, 84 DCISM, and 2111 IDC were included. Our experience with sentinel lymph node biopsy (SLNB) among patients with DCIS is reviewed. With the introduction of an organized mammographic screening, the incidence of ductal carcinoma in situ (DCIS) has experienced an important increase. ![]()
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