ReviewSentinel lymph node biopsy in patients with microinvasive breast cancer: A systematic review and meta-analysis
Introduction
Microinvasive breast cancer comprises a subset of T1 breast cancer in which the focus of invasion is no larger than 1 mm in size.1 These foci of invasive cells are usually observed in the background of ductal carcinoma in situ (DCIS).2, 3
By definition, DCIS is preinvasive and does not have the potential to spread to regional lymph nodes. In the pre-sentinel lymph node biopsy (SLNB) era, axillary dissection in patients with DCIS was not recommended due to the high morbidity of the procedure and the questionable clinical benefit.4 In this new era of SLNB, where the method has become the standard of care in the staging of breast cancer due to the considerably lower morbidity than axillary dissection,5, 6 SLNB can be recommended in patients with DCIS in the preoperative biopsy in certain circumstances. For instance, SLNB can be recommended when a mastectomy is indicated, as axillary staging by SLNB is essentially impossible if an invasive tumor is found with examination of surgical specimens.7
SLNB is also recommended if microinvasion is found on final pathology.7 However, the evidence for this recommendation is considered insufficient because the studies that underlies the recommendation are mostly retrospective with small sample size.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31
The purpose of this meta-analysis is to gather all available evidence and evaluate the role of SLNB in patients with microinvasive breast cancer.
Section snippets
Search strategy
We conducted a comprehensive systematic electronic search through MEDLINE and ISI Web of Knowledge, without year or language restriction, by using the following searching algorithm: (microinvasive OR occult) AND (breast OR mammary) AND (cancer OR carcinoma OR tumor OR malign*) AND (sentinel OR sentinel node biopsy OR SLNB). The last search was updated on April 2013.
We also conducted secondary referencing by manually reviewing reference lists of potentially eligible articles. Additionally, the
Eligible studies
A total of 225 abstracts were identified with the search criteria; of these, 42 full-text articles were reviewed as potentially eligible and 24 met the inclusion criteria (Fig. 1).
Fifteen studies9, 12, 13, 15, 16, 17, 19, 20, 23, 24, 25, 26, 28, 29, 31 were retrospective, 78, 10, 11, 18, 21, 22, 27 were retrospective with retrieval of data from a prospectively collected database while two14, 30 was prospective. The number of patients with microinvasive breast cancer included in the eligible
Discussion
This meta-analysis of nearly 1000 patients with microinvasive breast cancer who underwent SLNB showed that the SLN-positivity rate for macrometastasis in those patients was low (3.2%). Even in the worst-case scenario, based on the 95% confidence interval, the positivity rate remained acceptably low, namely 5.6%. Similar low positivity rates were observed for micrometastases or ITC.
Microinvasive breast cancer is mainly observed after postoperative pathologic analysis in the setting of DCIS. The
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Breast ductal carcinoma in situ with micro-invasion versus ductal carcinoma in situ: a comparative analysis of clinicopathological and mammographic findings
2021, Clinical RadiologyCitation Excerpt :DCIS theoretically cannot metastasise, whereas approximately 3% of cases are found to have positive lymph nodes in practice,24–26 and the reported rate in DCIS-MI ranges from 5% to 10%.9,13,23,27–29 A meta-analysis of 24 studies by Gojon et al.30 found that the sentinel lymph node metastasis rate in DCIS-MI was approximately 7.2%, with approximately 3.2% macrometastasis and 4% micrometastasis. The present findings that the axillary lymph node metastasis rate in DCIS-MI was significantly higher than that in DCIS (6.6% versus 1.3%) and that the axillary macrometastasis rate in DCIS-MI was 3.9% were in line with previous studies.
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2016, Clinical Lung CancerCitation Excerpt :This raises the possibility that the discrimination of AIS and MIA might not be clinically important. Although drawing parallels between the management of AIS and MIA and the management of breast ductal carcinoma in situ and microinvasive ductal carcinoma seems valid, the diagnosis of microinvasion in breast cancer can result in sentinel lymph node biopsy.51 However, no similar additional clinical intervention has been proposed in most studies for a diagnosis of MIA.
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