Meghan R Flanagan1, Michelle Stempel1, Edi Brogi2, Monica Morrow1, Hiram S Cody3. 1. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. codyh@mskcc.org.
Abstract
BACKGROUND: Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM. METHODS: Overall, 369 consecutive patients (2007-2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging. RESULTS: Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1. CONCLUSIONS: Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy.
BACKGROUND: Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM. METHODS: Overall, 369 consecutive patients (2007-2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging. RESULTS: Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1. CONCLUSIONS: Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy.
Authors: Beom Seok Ko; Woo Sung Lim; Hee Jeong Kim; Jong Han Yu; Jong Won Lee; Su Bum Kwan; Yu Mi Lee; Byung Ho Son; Gyung Yup Gong; Sei Hyun Ahn Journal: Ann Surg Oncol Date: 2011-06-02 Impact factor: 5.344
Authors: Danielle N Margalit; Meera Sreedhara; Yu-Hui Chen; Paul J Catalano; Paul L Nguyen; Mehra Golshan; Beth A Overmoyer; Jay R Harris; Jane E Brock Journal: Ann Surg Oncol Date: 2012-09-07 Impact factor: 5.344
Authors: Gary H Lyman; Sarah Temin; Stephen B Edge; Lisa A Newman; Roderick R Turner; Donald L Weaver; Al B Benson; Linda D Bosserman; Harold J Burstein; Hiram Cody; James Hayman; Cheryl L Perkins; Donald A Podoloff; Armando E Giuliano Journal: J Clin Oncol Date: 2014-03-24 Impact factor: 44.544
Authors: Pill Sun Paik; Nam Sun Paik; Eun Sook Lee; Jung Eun Choi; Joon Jeong; Hyun Jo Youn; Chang Ik Yoon; Soo Youn Bae; Tae-Kyung Yoo Journal: Ann Surg Treat Res Date: 2022-06-07 Impact factor: 1.766