Lumpectomies for DCIS without Sentinel Node Biopsy – Patient Selection and 5 Year Follow-Up
Roshan K Patel, Michael L Cibull, Patrick C McGrath, Wright R Heather, Elaina A Pirruccello, Vera V Krol, Yolanda M Brill, Luis M Samayoa. Univeristy of Kentucky, Lexington, KY
Background: The role of Sentinel Node Biopsy (SNB) in patients with Ductal Carcinoma In-Situ (DCIS) is largely based on data showing up to 20% incidence of axillary metastasis. While accurate at the time, these studies could not have taken into account the radiographic capabilities currently available for the diagnosis of the disease. Based on their initial radiologic findings, this study focuses on the selection of DCIS patients not needing SNB at the time of lumpectomy and presents 5 year follow up data on patients treated with lumpectomy + radiation alone.
Design: The incidence of invasive (inv.) and metastatic carcinoma (ca) in 225 patients with radiographic and/or histologic diagnosis of DCIS see Figure 1, was correlated with the following: extent of microcalcifications (m-Ca++) up to 50 mm; characteristics of the m-Ca++ (linear, segmental, clustered, pleomorphic, amorphous and casting); m-Ca++ alone vs m-Ca++ with associated parenchymal changes; unicentric vs multicentric disease; lumpectomies vs mastectomies specimens; and extent of axillary and inv. ca.
Results: See Table 1
Conclusions: See Table 2
|Patients' Radiographic Characteristics and NCB diagnoses||Incidence of metastatic carcinoma at the time of primary surgery||SNB at the time of Lumpectomy||No SNB at the time of Lumpectomy||SNB as a second procedure|
|Micro-Calcifications alone & NCB Dx of DCIS||0%||xxxxx||At surgeon's discretion, depending on size of the invasive carcinoma if present|
|Micro-Calcifications alone & NCB DX of DCIS + microinvasive ca||0%||xxxxx||At surgeon's discretion, depending on size of the invasive carcinoma if present|
|Micro-Calcificatinos with associated parenchymal abnormalites & NCB Dx of DCIS alone or with microinvasive or invasive ca||13%||xxxxx|
|Micro-Calcificatinos with associated well defined masses (mammographic and sonographic) & NCB Dx of DCIS alone or DCIS + microinvavise ca or inv carcinoma||32%||xxxxx|