Skip to main content
SpringerLink
Log in

Sentinel Lymph Node Metastasis in Microinvasive Breast Cancer

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background:Ductal carcinoma in situ with microinvasion (DCISM) is a separate pathological entity, distinct from pure ductal carcinoma in situ (DCIS). DCISM is a true invasive breast carcinoma with a well-known metastatic potential. Currently, there is controversy regarding the indication for complete axillary dissection (CAD) to stage the axilla in patients with DCISM. The role of CAD is questioned given its morbidity and reported low incidence of axillary involvement. Sentinel lymph node biopsy (SLNB) may obviate the need for CAD in these patients without compromising the staging of the axilla and the important prognostic information.

Methods:From March 1996 to December 2002, 4602 consecutive patients with invasive breast carcinoma underwent SLN biopsy. Of these, 41 patients with DCISM were selected.

Results:Metastasis in the SLN were detected in 4 of 41 (9.7%) patients. Two of the 4 patients had only micrometastasis in the SLN. In three patients, the SLN was the only positive node after CAD.

Conclusions:SLN biopsy should be considered as a standard procedure in DCISM patients. SLNB can detect nodal micrometastasis and accurately stage the axilla avoiding the morbidity of a CAD. Complete AD may not be mandatory if only the SLN contains micrometastatic disease. Informed consent is very important in the decision not to undergo CAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. International (Ludwig) Breast Cancer Study Group. Prognostic Importance of Occult Axillary lymph Node micrometastasis from Breast Cancers. Lancet 1990; 335: 1565–8.

    Google Scholar 

  2. Greco M, Agresti R, Cascinelli N, et al. Breast cancer patients treated without axillary surgery: clinical implications and biologic analysis. Ann Surg 2000; 232: 1–7.

    Article  PubMed  CAS  Google Scholar 

  3. Wong SL, Chao C, Edwards MJ, et al. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg 2002; 184: 492–8;discussion 498.

    Article  PubMed  Google Scholar 

  4. Fentiman IS, van Zijl J, Karydas I, et al. Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10850 comparing modified radical mastectomy with tumorectomy plus tamoxifen. Eur J Cancer 39: 300–8, 2003 Feb.

    Article  PubMed  CAS  Google Scholar 

  5. Wong JH, Kopald KH, Morton DL. The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer. Arch Surg 1990; 125: 1298–302.

    PubMed  CAS  Google Scholar 

  6. Silver SA, Tavassoli FA. Mammary ductal carcinoma in situ with microinvasion. Cancer 1998; 82: 2382–90.

    Article  PubMed  CAS  Google Scholar 

  7. De Cicco C, Cremonesi M, Luini A, et al. Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 1998; 39: 2080–4.

    PubMed  CAS  Google Scholar 

  8. Gennari R, Galimberti V, De Cicco C, et al. Use of Technetium 99m labeled colloid albumin for preoperative and intra-operative localization of non-palpable breast lesions. J Am Coll Surg 2000; 190: 692–699.

    Article  PubMed  CAS  Google Scholar 

  9. Schrenk P, Wayand W. Sentinel-node biopsy in axillary lymph-node staging for patients with multicentric breast cancer. Lancet 2001; 357: 122.

    Article  PubMed  CAS  Google Scholar 

  10. Rosen PP, Oberman H. Tumors of the mammary gland. Washington, DC: Armed Forces Institute of Pathology, 1993.

    Google Scholar 

  11. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer, I: the value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 2002; 41(3A): 151.

    Article  Google Scholar 

  12. Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91: 368–73.

    Article  PubMed  CAS  Google Scholar 

  13. Veronesi U, Zurrida S, Mazzarol G, Viale G. Extensive Frozen Section Examination of Axillary Sentinel Nodes to Determine Selective Axillary Dissection. World J Surg 2001; 25: 806–8.

    Article  PubMed  CAS  Google Scholar 

  14. Silverstein MJ. Ductal carcinoma in situ with microinvasion. In: Silverstein MJ, ed. Ductal Carcinoma In Situ of Breast. Baltimore: Williams & Wilkins, 1997: 557–62.

    Google Scholar 

  15. Wasserberg N, Morgenstern S, Schachter J, Fenig E, Lelcuk S, Gutman H. Risk Factors for Lymph Node Metastases in Breast Carcinoma In Situ With Minimal Invasive Component. Arch Surg 2002; 137: 1249–52.

    Article  PubMed  Google Scholar 

  16. American Joint Committee on Cancer. Cancer Staging Manual, 5th ed. Philadelphia: Lippincott-Raven Publishers, 1997: 171–8.

    Google Scholar 

  17. Hoda SA, Chiu A, Prasad ML, Giri D, Hoda RS. Are microinvasion and micrometastasis in breast cancer mountains or molehills? Am J Surg 2000; 180: 305–8.

    Article  PubMed  CAS  Google Scholar 

  18. Rosner D, Lane WW, Penetrante R. Ductal carcinoma in situ with microinvasion: a curable entity surgery alone without need for adjuvant therapy. Cancer 1991; 67: 1498–503.

    Article  PubMed  CAS  Google Scholar 

  19. Jimenez RE, Visscher DW Clinicopathologic analysis of microscopically invasive breast carcinoma. Human Pathol 1998; 29: 1412–9.

    Article  CAS  Google Scholar 

  20. Le Bouëdec G, Penault-Llorca F, De Latour M, et al. Carcinoma Canalaire Micro-invasif du Sein. J Gynecol Obstet Biol Reprod 1999; 28: 10–6.

    Google Scholar 

  21. Padmore RF, Fowble B, Hoffman J, Rosser C, Hanlon A, Patchefsky AS. Microinvasive breast carcinoma: clinicopathologic analysis of a single institution experience. Cancer 2000; 88: 1403–9.

    Article  PubMed  CAS  Google Scholar 

  22. Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995; 222: 394–9.

    Article  PubMed  CAS  Google Scholar 

  23. Nasser IA, Lee AK, Bosari S, et al. Occult axillary lymph node metastases in “node-negative” breast carcinoma. Hum Pathol 1993; 24: 950–7.

    Article  PubMed  CAS  Google Scholar 

  24. McGuckin MA, Cummings MC, Walsh MD. Occult axillary node metastasesin breast cancer. their detection and prognostic significance. Br J Cancer 1996; 73: 88–95.

    PubMed  CAS  Google Scholar 

  25. Cote RJ, Peterson HF, Chaiwun B. Role of the Immunohistochemical detection of lymph node metastases in Management of Breast Cancer Study Group. Lancet 1999; 354: 896–900.

    Article  PubMed  CAS  Google Scholar 

  26. Pendas S, Dauway E, Giuliano R, Ku NN, Cox CE, Reintgen DS. Sentinel node biopsy in DCIS patients. Ann Surg Oncol 2000; 7: 15–20.

    Article  PubMed  CAS  Google Scholar 

  27. Intra M, Veronesi P, Mazzarol G, et al. Axillary Sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 2003; 138: 309–13.

    Article  PubMed  Google Scholar 

  28. Zavotsky J, Hansen N, Brennan MB, Turner R, Giuliano A. Lymph Node Metastasis from Ductal carcinoma In Situ With Microinvasion. Cancer 1999; 85: 2439–2443.

    Article  PubMed  CAS  Google Scholar 

  29. Klauber-De More N, Tan LK, Liberman L. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal in situ and ductal carcinoma in situ with microinvasion? Ann Surg Oncol 2000; 7: 636–42.

    Article  CAS  Google Scholar 

  30. TNM Classification of Malignant Tumors by International Union Against Cancer (UICC). Breast Tumors. 6th edition. Sobin LH, Wittekind Ch, eds. New York: Wiley-Liss, 2002.

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Breast Unit, European Institute of Oncology, Milan, Italy

    Mattia Intra MD, Stefano Zurrida MD, Roberto Gennari MD, Paolo Arnone MD, Guillermo Bassani MD & Antonio Opazo MD

  2. Department of Pathology and Laboratory Medicine, University of Milan School of Medicine, Milan, Italy

    Fausto Maffini MD, Angelica Sonzogni MD & Giuseppe Viale MD, FRCPath

  3. Department of Nuclear Medicine, European Institute of Oncology, Milan, Italy

    Giuseppe Trifirò MD & Giovanni Paganelli MD

  4. Division of Chemoprevention, European Institute of Oncology, Milan, Italy

    Umberto Veronesi MD, PhD

  5. European Institute of Oncology, Via Ripamonti, 435, 20141, Milano, Italy

    Mattia Intra MD

Authors
  1. Mattia Intra MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefano Zurrida MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fausto Maffini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angelica Sonzogni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuseppe Trifirò MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Gennari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Arnone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Guillermo Bassani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Opazo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giovanni Paganelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giuseppe Viale MD, FRCPath
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Umberto Veronesi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mattia Intra MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Intra, M., Zurrida, S., Maffini, F. et al. Sentinel Lymph Node Metastasis in Microinvasive Breast Cancer. Ann Surg Oncol 10, 1160–1165 (2003). https://doi.org/10.1245/ASO.2003.04.009

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2003.04.009

Key Words

Search

Navigation