Visibility in Ultrasonography as the Strongest Invasion Predictor in Ductal Carcinoma in Situ in a Retrospective Study

Česká verzia

Authors: P. Vrtělová ¹; O. Coufal ¹ ; T. Pavlík ²; M. Bažout ¹; V. Fait ¹
Authors place of work: Oddělení chirurgické onkologie, Masarykův onkologický ústav, Brno ¹; Institut biostatistiky a analýz, MU Brno ²
Published in the journal: Klin Onkol 2009; 22(6): 278-283
Category: Original Articles

Summary

Background:
Detection of ductal carcinoma in situ (DCIS) of the breast has markedly increased since the introduction of screening mammography. Current management of this preinvasive lesion comprises complete margin‑free resection of the tumour. Lymph node staging is still not indicated as a standard procedure but we can find published cases of pure DCIS with lymph node involvement as well as a high proportion of invasive carcinomas in the final histopathology. The aim of this study was to determine the proportion of invasive tumours in our group of patients operated on for DCIS, to analyse the predictive factors of invasion and to assess the frequency of lymph node metastases.

Design and Subjects:
From 2006 to 2008, a retrospective review was conducted of 179 patients operated on at Masaryk Memorial Cancer Institute for the initial diagnosis of DCIS carried out by core‑needle biopsy; in 117 of them, regional lymph node staging was performed.

Methods and Results:
In the final histopathological results, an invasive lesion was found in 34% of cases. The expected predictive factors of invasion were statistically analysed by Fisher’s exact and Chi‑ square test. Preoperative ultrasound‑ guided core‑needle biopsy (p = 0.014) related to ultrasound detection of the lesion (p = 0.023) was shown to be the statistically most significant predictive factor. Mammographic character (p = 0.105) or size (p = 0.077), histopathological grade (p = 0.104), multifocality (p = 0.544) and age (p = 0.212) did not show any statistical significance. Lymph node metastases were detected in fewer than 10% of cases of invasive carcinoma. There was no detection of lymph node involvement in pure DCIS. Conclusions: We recommend performing primary sentinel node biopsy in DCIS unambiguously detected by ultrasound and in patients treated by total mastectomy where, in the case of invasive carcinoma, subsequent identification of the sentinel node would be difficult.

Key words:
breast cancer – DCIS – sentinel lymph node biopsy – lymph node dissection – prediction

Zdroje

1. Erstner VL, Ballard‑ Barbash R, Barlow WE et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 2002; 94: 1546– 1554.

2. Nechanská B, Srb T. Zhoubné nádory v roce 2006. Aktuální informace Ústavu zdravotnických informací a statistiky České republiky [online] [cit. 2009– 09– 14]. Dostupný z www.uzis.cz/ download_file.php?file=3518.

3. Cox CE, Nguyen K, Gray RJ et al. Importace of lymphatic mapping in ductal carcinoma in situ : why map DCIS? Am Surg 2001; 67(6): 513– 519.

4. Goral A, Douglas‑ Joness A, Monypenny I et al. Is there a role of sentinel lymph node biopsy in ductal carcionoma in situ? Analysis of 587 cases. Breast Cancer Res Treat 2006; 98: 311– 314.

5. Wahedna Y, Evans AJ, Pinder SE et al. Mammographic size of ductal carcinoma in situ does not predict the presence of an invasive focus. Eur J Cancer 2001; 37(4): 459– 462.

6. Yen TW, Hunt JK, Ross MI. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ: a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ. J Am Coll Surg 2005; 200: 516– 526.

7. Wilkie C, White L, Dupot E et al. An update of sentinel node mapping in patiens with ductal carcinoma in situ. Am J Surg 2005; 190(4): 563– 566.

8. Huo L, Sneige N, Hunt KK et al. Predictors of invasion in patients with core‑needle biopsy‑ diagnosed ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy in ductal carcinoma in situ. Cancer 2006; 107: 1760– 1768.

9. Dillon MF, McDermott EW, Quinn CM et al. Predictors of invasive disease in breast cancer when core needle biopsy demonstrates DCIS only. J Surg Oncol 2006; 93: 559– 563.

10. Sakr R, Antoine M, Barranger E et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma. Breast J 2008; 14(1): 55– 60.

11. Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2 282 patients with breast carcinoma. World J Surg 2001; 25(6): 767– 72.

12. Leopard GD, Swain SM. Ductal carcinoma in situ, complexities and challenges. J Natl Cancer Inst 2004; 96: 906– 920 (review).

13. Veronesi P, Intra M, Vento AR. Sentinel node biopsy for localised ductal carcinoma in situ. Breast 2005; 14: 520– 522.

14. Gatěk J, Hnátek L, Dudešek B et al. Biopsie sentinelové uzliny u karcinomu prsu v klinické praxi. Rozhl Chir 2008; 87(4): 180– 185.

15. Mabry H, Giuliano AE, Silverstein MJ. What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ? Am J Surg 2006; 192(4): 455– 457.

16. Dominguez FJ, Golshan M, Black DM et al. Sentinel node biopsy is important in mastectomy for ductal carcinoma in situ. Ann Surg Oncol 2008; 15(1): 268– 273. Epub 2007 Sep 22.

17. Polom K, Murawa D, Wasiewicz J et al. The role of sentinel node biopsy in ductal carcinoma in situ of the breast. Eur J Surg Oncol 2009; 35(1): 43– 47. Epub 2008 Aug 23.

18. Fait V. Sentinelová biopsie a možnosti využití v současné onkochirurgii. Klin Onkol 2008; 21(1): 5– 19.

19. Coufal O, Fait V, Foltinová V et al. Chirurgická léčba karcinomu prsu v MOÚ. Rozhl Chir 2007; 86(10): 540– 547.

20. Fait V, Chrenko V. Sentinel node biopsy in breast cancer: short time results show appropriate regional control. Neoplasma 2007; 54(3): 256– 261.