Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 10, 2016; 7(2): 258-264
Published online Apr 10, 2016. doi: 10.5306/wjco.v7.i2.258
Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ
Ahmed Yahia Al-Ameer, Sahar Al Nefaie, Badria Al Johani, Ihab Anwar, Taher Al Tweigeri, Asma Tulbah, Mohmmed Alshabanah, Osama Al Malik
Ahmed Yahia Al-Ameer, Department of Surgery, Armed Forces Hospital Southern Region, Khamis Mushyt 61961, Kingdom of Saudi Arabia
Sahar Al Nefaie, Department of Surgery, King Abdul Aziz Specialist Hospital, Taif 21944, Kingdom of Saudi Arabia
Badria Al Johani, Ihab Anwar, Osama Al Malik, Breast and Endocrine Section, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh 1121, Kingdom of Saudi Arabia
Taher Al Tweigeri, Medical Oncology Section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Kingdom of Saudi Arabia
Asma Tulbah, Anatomical Pathology Section, Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Kingdom of Saudi Arabia
Mohmmed Alshabanah, Radiation Oncology Section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Kingdom of Saudi Arabia
Author contributions: Al-Ameer AY, Al Nefaie S designed and performed the research and wrote the paper; Al Johani B contributed to the analysis; Anwar I and Al Tweigeri T provided clinical advice and reviewed the English in the paper; Tulbah A and Alshabanah M provided clinical advice; Al Malik O designed the research and supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of King Faisal Specialist Hospital and Research Centre.
Informed consent statement: Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Fukushima Medical University.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Osama Al Malik, Breast and Endocrine Section, Department of Surgery, MBC 40, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia. omalik@kfshrc.edu.sa
Telephone: +966-11-4427757 Fax: +966-11-4424260
Received: June 5, 2015
Peer-review started: June 5, 2015
First decision: July 26, 2015
Revised: October 26, 2015
Accepted: January 27, 2016
Article in press: January 29, 2016
Published online: April 10, 2016
Abstract

AIM: To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS).

METHODS: A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital. The accuracy of performing SLNB in CD-DCIS, the rate of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an image-guided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive.

RESULTS: Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%.

CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy.

Keywords: Non-invasive tumor, Sentinel lymph node biopsy, Ductal carcinoma in situ, Diagnosis, Breast cancer

Core tip: While most ductal carcinoma in situ (DCIS) cases present with a radiologically detected abnormality, our sample represented a rare group of ductal carcinoma which was detected clinically. This study had a specific objective to determine the indications for sentinel lymph node in clinically detected DCIS. There are very few studies worldwide tracking this specific group, and there is no screening program in our community for breast cancer. This study will help communities who have no screening program to put protocols in place for such a specific group of patients.