NEW YORKIn patients with ductal carcinoma in situ (DCIS), the
identification of positive sentinel lymph nodes (SLNs) is unlikely to
be clinically significant, David Brenin, MD, of Columbia-Presbyterian
Medical Center, said at the San Antonio Breast Cancer Symposium.
Several recent studies of SLN biopsy in DCIS patients have shown
positive results in 6% to 14% of patients. Dr. Brenin pointed out
that these rates are higher than the 1% to 2% prevalence seen with
axillary node dissection and have raised the question of whether
axillary metas-tases identified by SLN biopsy are clinically
significant in DCIS patients.
If positive sentinel lymph nodes were clinically significant
for DCIS patients, then one would expect some proportion of DCIS
patients to develop distant metastases without first or
simultaneously developing an invasive locoregional recurrence or
invasive second breast cancer, Dr. Brenin said.
The study involved 432 DCIS patients treated between 1980 and 1998 at
Columbia-Presbyterian. None had any type of axillary staging, and no
patient had microinvasion.
At a median follow-up of 3 years, only two patients had died of
metastatic breast cancer or developed a distant metastasis that was
not preceded by or accompanied by an invasive local recurrence or
invasive second primary breast cancer. The actuarial disease-specific
survival was 98.2%, which was unchanged if the analysis was
restricted to patients with 5-year follow-up and was little changed,
at 97.3%, in patients followed for 7 years.
The findings were virtually identical to those of a second study by
Dr. Brenin and his colleagues, showing 97.6% 10-year disease-specific
survival in 326 DCIS patients who underwent surgery and axillary
Our results and others show that breast cancer survival for
DCIS patients treated without axillary staging of any kind is
excellent, Dr. Brenin said. Therefore, metastatic disease
identified through SLN techniques in DCIS patients is unlikely to be
In response to a question, Dr. Brenin agreed that axillary staging is
appropriate and useful for selected DCIS patients, eg, those with
large palpable tumors.