Is Sentinel Lymph Node Biopsy Necessary in Ductal Breast Carcinoma in situ?

Abstract

Introduction: Carcinoma in situ accounts for approximately 15% of breast cancers. By definition, it does not exceed the basal membrane, which would imply zero theoretical risk for lymph node metastasis. However, according to the literature, 1-13% of sentinel lymph node biopsies (SNB) in patients with carcinoma ductal in situ (DCIS) are positive. Objective: To determine the prevalence of sentinel lymph node metastasis in patients with DCIS treated surgically at a referral hospital in Northeastern Brazil. Method: Cross-sectional and descriptive study using secondary data obtained from the medical records of patients with breast cancer that underwent surgery at the Cancer Institute of Ceará (ICC) between 2002 and 2012. The data were analyzed with the software Epi Info 7.0. Results: The study population included 746 patients with primary breast tumors, being 106 (14%) of them diagnosed with DCIS on the initial histological examination. Fifty-four patients (51%) underwent mastectomy and 52 (49%) conservative surgery. SNB was performed in 88 (83%) of 106 cases of DCIS, but only one case (1.1%) was positive. During follow-up of the 106 DCIS patients, 2 had local recurrence and 1 had loco regional recurrence. Conclusion: SNB in patients with DCIS alone revealed a low prevalence of lymph node metastasis, matching most studies on the topic. Despite the low morbidity of SNB, the additional financial cost and its negligible impact on therapeutic decision suggest the procedure is not indispensable in this patient population.