Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

• Published in: Breast cancer targets and therapy Vol. 13; pp. 409 - 417
• Main Authors: Sá, Rafael da Silva, Logullo, Angela Flávia, Elias, Simone, Facina, Gil, Sanvido, Vanessa Monteiro, Nazário, Afonso Celso Pinto
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Biopsy; Breast cancer; Cancer; Carcinoma, Ductal; Cell membranes; Diagnosis; ductal carcinoma in situ; Epithelium; Estrogens; Health aspects; Hospitals; Invasiveness; Lumpectomy; Lymph nodes; Lymphatic system; Mammography; Mastectomy; Medical prognosis; Medical records; Original Research; Pathology; Patients; positive sentinel lymph node; Surgery; Tumors; Ultrasonic imaging; underestimation rates; Brazil; ductal carcinoma in situ; breast cancer; positive sentinel lymph node; underestimation rates
• ISSN: 1179-1314; 1179-1314
• DOI: 10.2147/BCTT.S314447

Mammography screening has become widely spread and provided a marked increase in ductal carcinoma in situ (DCIS) diagnosis. In DCIS, the ductal epithelium proliferates without invasion through the basal cell membrane. However, histologic underestimation can happen in some cases. To analyze the rate of histologic underestimation (histopathologic results upgraded to invasive carcinoma after surgery) and the rate of positive results of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS in a Brazilian public hospital. We reviewed medical records of all consecutive patients admitted between 2009 and 2013 whose initial diagnosis was DCIS through core needle biopsy. DCIS cases with a high risk of invasion underwent SLNB. We excluded cases with invasion or micro-invasion components in the first biopsy. A total of 86 women were included, most with microcalcifications as the primary radiological lesion (73.2%), and underwent preoperative biopsy, with an invasive component in 21 (24.4%) in the final pathology report. Most had invasive carcinoma of no special type (NST): 52.3% (n = 11) and microinvasive tumors (7 cases, 33.3%). The main factors associated with histologic underestimation were nodular lesion (61.9%, p<0.001) and an ultra-sonography-guided biopsy (71.4%, p=0.0005). The positivity rate of SLNB was 4.3%. All these patients underwent mastectomy, and the initial histologic pattern was solid DCIS. The "histologic underestimation" rate among patients with DCIS was not low, and less than 5% of patients who underwent SLNB had axillary positivity. This result suggests that patients who have DCIS and a high risk of invasion and undergoing mastectomy should have SLNB. As to the patients who will undergo lumpectomy, SLNB could be omitted and could be performed if patients have upgraded to invasive breast cancer.