Klin Onkol 2009; 22(6): 278-283.
Summary
Background: Detection of ductal carcinoma in situ (DCIS) of the breast has markedly increased since the introduction of screening mammography.
Current management of this preinvasive lesion comprises complete margin‑free resection of the tumour. Lymph node staging is still not indicated
as a standard procedure but we can find published cases of pure DCIS with lymph node involvement as well as a high proportion of invasive
carcinomas in the final histopathology. The aim of this study was to determine the proportion of invasive tumours in our group of patients operated
on for DCIS, to analyse the predictive factors of invasion and to assess the frequency of lymph node metastases. Design and Subjects: From
2006 to 2008, a retrospective review was conducted of 179 patients operated on at Masaryk Memorial Cancer Institute for the initial diagnosis of
DCIS carried out by core‑needle biopsy;
in 117 of them, regional lymph node staging was performed. Methods and Results: In the final histopathological
results, an invasive lesion was found in 34% of cases. The expected predictive factors of invasion were statistically analysed by Fisher’s
exact and Chi‑ square test. Preoperative ultrasound‑ guided core‑needle biopsy
(p = 0.014) related to ultrasound detection of the lesion (p = 0.023)
was shown to be the statistically most significant predictive factor. Mammographic character (p = 0.105) or size (p = 0.077), histopathological
grade (p = 0.104), multifocality (p = 0.544) and age (p = 0.212) did not show any statistical significance. Lymph node metastases were detected
in fewer than 10% of cases of invasive carcinoma. There was no detection of lymph node involvement in pure DCIS. Conclusions: We recommend
performing primary sentinel node biopsy
in DCIS unambiguously detected by ultrasound and in patients treated by total mastectomy where, in
the case of invasive carcinoma, subsequent identification of the sentinel node would be difficult.
