Revisit the practice of lymph node biopsy in patients diagnosed as ductal carcinoma in situ before operation: a retrospective analysis of 682 cases and evaluation of the role of breast MRI

World Journal of Surgical Oncology

Yu-Jun Chang¹  Chiung-Ying Liao²  Hwa-Koon Wu²  Wen-Pei Wu³  Yi-Lin Chang⁴  Shou-Jen Kuo⁵  Shou-Tung Chen⁵  Hung-Wen Lai⁶  Dar-Ren Chen⁷ 

[1] Center for Research and Epidemiology, Big Data Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan;Department of Biomedical Imaging and Radiological Sciences, Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;Department of Radiology, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Minimal Invasive Surgery Research Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Tumor Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan;School of Medicine, Chung Shan Medical University, Taichung, Taiwan;Department of Biomedical Imaging and Radiological Sciences, Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;Chang Gung University College of Medicine, Taoyuan City, Taiwan;Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Division of General Surgery, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, 500, Changhua, Taiwan;School of Medicine, Chung Shan Medical University, Taichung, Taiwan;

关键词: Ductal carcinoma in situ;    Upgrade;    Lymph node metastasis;    Sentinel lymph node biopsy (SLNB);    Mastectomy;   

DOI  :  10.1186/s12957-021-02336-w

来源: Springer

【 摘 要 】

BackgroundThe optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients was evaluated.MethodsPatients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast MRI for ALN evaluation, predictors of breast and ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed.ResultsA total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients who received breast conserving surgery and 40.7% for mastectomy (p < 0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node-negative breast cancer patients with MRI tumor size < 3 cm, the NPV was 96.4%, and all these false-negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size < 3 cm and node negative suitable for BCS could safely omit SLNB if whole breast radiotherapy is to be performed.ConclusionBreast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference.

【 授权许可】

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