Faculty Collaboration Database

The Use of Sentinel Lymph Node Biopsy in Patients Undergoing Mastectomy for DCIS. Clin Breast Cancer 2024 Oct;24(7):611-619

Date

08/11/2024

Pubmed ID

39127597

Pubmed Central ID

PMC11402566

DOI

10.1016/j.clbc.2024.07.003

Scopus ID

2-s2.0-85200951572 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Current guidelines do not recommend routine sentinel node biopsy (SLNB) for ductal carcinoma in situ (DCIS), except in the setting of mastectomy or microinvasive disease. This study aimed to evaluate national SLNB utilization in women undergoing upfront mastectomy for DCIS, identify predictors of SLNB utilization, and determine the percentage with a positive SLNB.

METHODS: A retrospective cohort analysis was performed using the NCDB of women with clinical DCIS who underwent upfront mastectomy between 2012 and 2017. Demographic and clinicopathologic variables were compared between patients who underwent SLNB and those who did not. Multivariate logistic regression models were used to identify factors associated with SLNB utilization and positive SLNB.

RESULTS: About 38,973 patients met inclusion criteria: 34,231 (88%) underwent SLNB and 4742 (12%) had no surgical axillary staging. Most patients were age 50-69 (51%), non-Hispanic White (71%), with private insurance (66%). On multivariate analysis, older patients were less likely to receive SLNB (P < .01), while patients with higher grade DCIS were more likely to undergo SLNB (P < .01). In those who underwent SLNB (n = 34,231), only 1,149 (3.4%) had nodal involvement. Non-Hispanic Black patients had increased odds of a positive SLNB (P < .01), while those with estrogen receptor positive disease were less likely to be node positive (OR 0.68, P < .001).

CONCLUSIONS: While 88% of patients had a SLNB, only 3.4% were found to be node positive. Given this low rate, it is reasonable to consider SLNB omission in select patients with low grade, hormone receptor positive DCIS undergoing upfront mastectomy.

Author List

Johnson MK, Cortina CS, Aldakkak M, Huang CC, Kong AL

Authors

Chandler S. Cortina MD Associate Professor in the Surgery department at Medical College of Wisconsin
Amanda L. Kong MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Axilla
Breast Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Female
Humans
Lymphatic Metastasis
Mastectomy
Middle Aged
Retrospective Studies
Sentinel Lymph Node Biopsy