Is Sentinel Lymph Node Biopsy Necessary in Patients with Ductal Carcinoma in situ of the Breast?

Abstract

Objectives: The number of patients diagnosed with ductal carcinoma in situ (DCIS) has increased in the past 20 years with the widespread use of mammography screening. This study aims to investigate which patients with DCIS should undergo sentinel lymph node biopsy (SLNB). Methods: Between 2008 and 2023, patients diagnosed with DCIS in the General Surgery Clinic were evaluated retrospectively. Age, clinical features, tumor nuclear grade, presence of comedonecrosis, tumor diameter, hormone receptor, presence of microinvasive components, axillary pathology, surgical interventions, locoregional recür-rences, overall and disease-free survival information of the patients were evaluated. Results: Forty-eight patients with a mean age of 52.2+12.4 years (25–76) were included in the study. Mastectomy was performed in 16, breast-conserving surgery in 32, SLNB in 21, axillary dissection in three, and no axillary-di-rected intervention was performed in 24 patients. Pure DCIS was detected in 44 patients and microinvasive component was detected in four patients (8.3%). No metastasis was detected after axillary sampling. It was statistically significant that a higher proportion of patients who underwent axillary intervention were in the mastectomy group and had diffuse microcalcifications in their mammograms (p<0.001 and p=0.009). Patients were followed up for a mean of 82.5 months, and locoregional recurrence was detected in 3 (6.25%) patients. One of the recurrences was due to DCIS, and the others were due to invasive cancer. The tumor sizes in these cases were above the average tumor size in the study. Conclusion: Although the absence of axillary metastasis in our study is attributed to the low number of patients and small mean tumor size, routine SLNB might not be performed in patients with DCIS due to the low rate of axillary metastasis. SLNB may be preferred only in cases where mastectomy will be performed.