suggestion made by study to surgeons treating DCIS w possible invasion

[Lani]

ABSTRACT: Value of Sentinel Lymph Node Biopsy in Breast Ductal Carcinoma in Situ Upstaged to Invasive Carcinoma
[The Breast Journal]
The role of sentinel lymph node (SLN) biopsy in patients with initial diagnosis of ductal carcinoma in situ (DCIS) is still a dilemma. Different studies are trying to define predicting factors of invasive cancer in DCIS. The aim of this study was to confirm the value of SLN biopsy in DCIS because of the invasive upstaging risk on final histology. Patients with initial diagnosis of DCIS and with axillary SLN biopsy were selected. All diagnoses were confirmed by biopsy of mammographic lesions. Surgical treatment was lumpectomy or mastectomy associated with SLN biopsy. Imprint stains were performed, and then serial sections were stained with hematoxylin and eosin (H&E) and with immunohistochemistry (IHC). A complete axillary lymph node dissection (ALND) was performed during the same surgery when a node metastasis was found. Eighty patients were enrolled in the study. Of the 61 patients who were initially diagnosed with DCIS, 12 (20%) were upstaged to microinvasive or invasive carcinoma and 9 (15%) had a metastatic SLN. Patients upstaged to invasive carcinoma had macrometastatic SLN immediately fed by a complete ALND. SLN micrometastases and isolated cells were detected by IHC and secondary complete ALND found an additional metastatic lymph node in one patient. Tumor size larger than 30 mm and mastectomy were the only significative predicting factors of upstaged disease (p < 0.0001) in our study. In patients with initial diagnosis of large DCIS programmed for mastectomy, SLN biopsy should be discussed in order to detect underlying invasive disease and to spare patients a second operating time.

[Melissa]

Sounds like to me all the surgeons should be doing a SNB.

[Jean]

Thanks Lani for the post.
There is a new member who posted today who was first dx. 1999
with a small cancer and neg. node. She has now experiencing a
recurrence and her dr. is surprised.

Melissa, although some surgeons consider SLN biopsey to be the standard of care there are some surgeons who do not perform the procedure.
That is why patients must be updated and knowledgable about their
treatment.

My feelings on SLN bipsey is the following: I do feel it should be performed to confirm whether the lymph is positive /or/negative.
Negative being favorable. But strangely enough I am not 100%
comfortable with a negative results. The all over path report must be
understood to make clear treatment decisions, such as Hopeful with
her low KI-67 levels...and myself with high levels.

I believe the strongest advantage of SLN biopsey is not having to have a
standard LN removal, which involves removing most of the nodes in the area of the tumor.

From what I was told back in '05, (maybe at that time surgeons were not doing many) it was a bit tricky to locate etc. even with the dye.
That one would want to have a surgeon who does them often and is expert in this.

This SLN mapping was started back in 1977 and began to be
used in 1994 in breast cancer....one has to ponder why these procedures are taking so long to be "Standard of Care"?

Regards,
jean

[Jean]

How accurate is SLN biopsey?

I think it is important to understand that while the SLN biopsey helps to stage a cancer there are (like anything else) false negatives. While the percentage is low it is vital to understand that
a cell can pass through and in fact other axillary lymph nodes do contain cancer. There could also be the presence of more than one sentinel node. Very important to have a surgeon who is truly proficient in this area. I had a close friend who was having a biopsey performed on
a tumor which was found and she had a wonderful surgeon - but
he was not a breast surgeon and after I discussed with her the SLN
biopsey and how critical it is that the surgeon have great experience with this procedure she decided to have her surgery done by a experienced breast surgeon who has a protocol for all aspects of this procedure.

Regards,
Jean

[Melissa]

I agree, the most important reason for the SNB is to possibly prevent LN removal. Bottom line is knowing your markers,agreesiviness etc. I just don't like what the surgeon told my friend, Oh it' DCIS, precancer, state 0, 98-100curable. Her cancer or should I say precaner is strong her2 and I wish her onc would push for Herceptin. Maybe there's too mush emphasis on the staging and not the markers. BUt I'm not the specialist. I've told her about this site and hopefully she'll log on and read. I remember reading about the Topo ll gene test when I was dx, before having AC and my onc told me there was no such test. But it appears that some, on this site, have had the test and it was at the time I was asking for it. So, I guess my onc was wrong. I know I wish I had found this site when I was dx.
Thanks, Melissa