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‘Sentinel Node Biopsy Unnecessary for Most DCIS Patients’

‘Sentinel Node Biopsy Unnecessary for Most DCIS Patients’

NEW YORK–A favorable long-term prognosis makes sentinel lymph node biopsy unnecessary for the vast majority of patients with ductal carcinoma in situ (DCIS), New York investigators have concluded from a 15-year follow-up of more than 300 patients.

Breast-cancer-specific survival ranged from 97% to 100% between 5 and 15 years after DCIS diagnosis and treatment that included axillary lymph node dissection. The survival is similar to that reported for DCIS patients who have had no axillary lymph node staging, Mahmoud El-Tamer, MD, a surgical oncologist at Columbia-Presbyterian Medical Center, said at the 22nd Annual San Antonio Breast Cancer Symposium.

“These results tell us, ‘Don’t do sentinel node biopsy on all DCIS patients,’” Dr. El-Tamer said. “There are some DCIS patients who should have lymph node dissections. These are patients who have large palpable disease. If the lesion is palpable, you can’t be sure it’s all DCIS. But in most cases, when you perform an axillary node dissection, the axilla will be free of disease.”

Dr. El-Tamer described the study as the “flip side” of another investigation he and his colleagues reported at the symposium . That investigation showed excellent disease-specific survival in more than 400 DCIS patients treated between 1980 and 1998 who did not undergo any type of axillary staging.

Dr. El-Tamer and his colleagues retrospectively reviewed findings from 326 DCIS patients who had a minimum of eight lymph nodes removed. The patient population included 286 patients who had modified radical mastectomy and 40 patients who had lumpectomy plus axillary node dissection. Among the lumpectomy patients, 78% received postoperative radiation therapy.

Only four of the 326 patients (1.2%) had lymph node involvement. At 5 years of follow-up, breast-cancer- specific survival was 99.6% for the entire cohort, declining only slightly to 97.6% at 10 and 15 years of follow-up.

“It’s unlikely that axillary staging by other techniques, such as sentinel node biopsy, will have a clinically significant impact on survival,” Dr. El Tamer concluded.

 
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