Is sentinel lymph node biopsy indicated in patients with a diagnosis of ductal carcinoma in situ? A systematic literature review and meta-analysis - 18/04/17
, Hannah Headon, M.B.B.S., B.Sc., Umar Wazir, M.B.B.S., M.R.C.S., M.Sc., Houssam Abtar, M.D., Abdul Kasem, M.D., F.R.C.S., Kefah Mokbel, M.S., F.R.C.S.Abstract |
Background |
Recent discussion has suggested that some cases of ductal carcinoma in situ (DCIS) with high risk of invasive disease may require sentinel lymph node biopsy (SLNB).
Methods |
Systematic literature review identified 48 studies (9,803 DCIS patients who underwent SLNB). Separate analyses for patients diagnosed preoperatively by core sampling and patients diagnosed postoperatively by specimen pathology were conducted to determine the percentage of patients with axillary nodal involvement. Patient factors were analyzed for associations with risk of nodal involvement.
Results |
The mean percentage of positive SLNBs was higher in the preoperative group (5.95% vs 3.02%; P = .0201). Meta-regression analysis showed a direct association with tumor size (P = .0333) and grade (P = .00839) but not median age nor tumor upstage rate.
Conclusions |
The SLNB should be routinely considered in patients with large (>2 cm) high-grade DCIS after a careful multidisciplinary discussion. In the context of breast conserving surgery, the SLNB is not routinely indicated for low- and intermediate-grade DCIS, high-grade DCIS smaller than 2 cm, or pure DCIS diagnosed by definitive surgical excision.
Le texte complet de cet article est disponible en PDF.Highlights |
• | SLNB in DCIS patients undergoing breast conserving surgery is still controversial. |
• | The incidence of SLNB positivity is higher in the preoperatively diagnosed DCIS. |
• | Larger tumor size and higher grade are significantly associated with SLNB positivity. |
• | These patients should be hence selectively considered for SLNB. |
Keywords : Sentinel lymph node biopsy, Ductal carcinoma in situ, Breast cancer
Plan
| This review was funded by grants from the Breast Cancer Hope Foundation (London, UK). |
|
| The authors declare no conflicts of interest. |
Vol 213 - N° 1
P. 171-180 - janvier 2017 Retour au numéro
Article précédent
- Three-dimensional laparoscopy vs 2-dimensional laparoscopy with high-definition technology for abdominal surgery: a systematic review
- Charlotte Fergo, Jakob Burcharth, Hans-Christian Pommergaard, Niels Kildebro, Jacob Rosenberg
- Development of a rapid response plan for intraoperative emergencies: the Circulate, Scrub, and Technical Assistance Team
- David Earle, Diane Betti, Emilia Scala
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?