Micrometastases in the Sentinel Lymph Nodes of Patients with Ductal Carcinoma In-Situ of the Breast

Kim, Jeong Han; Song, Jeong Yoon; Nam, Suk Jin; Ko, Young Hyeh; Yang, Jung Hyun

Abstract

PURPOSE: Although the axillary lymph node (LN) status is the most important prognostic indicator in breast cancer, due to the very low rae of axillary metastasis, the need for an axillary lymph node dissection in ductal carcinoma in situ (DCIS) and DCIS with a microinvasion (DCIS-M) is still controversial. The sentinel lymph node procedure has emerged as a potential alternative to avoid unnecessary axillary lymph node dissection. This study was performed in order to compare the frequency of metastasis in the sentinel node analyzed by various techniques, and the lymph nodes obtained by a routine axillary dissection in patients with DCIS and DCIS-M.
METHODS
A total of 207 patients who underwent surgery for DCIS and DCIS-M at the Samsung Medical Center between 1994 and 2001, including 27 patients who underwent a sentinel node biopsy, were enrolled in this study. The sentinel node was serially cut into 20 slides per paraffin block of which 3 slides were immunostained with anti-cytokeratin antibodies. The medical records for the clinical, radiological, and pathological findings were reviewed.
RESULTS
The patients were 205 women and 2 men with a mean age of 47 years. The patients presented with a palpable mass (50.2%), abnormal radiological findings detected in a routine check-up (35.7%), nipple discharge (10.1%), and others (3.9%). The operations applied were a total mastectomy in 120 patients, a lumpectomy in 50, and a lumpectomy with an axillary dissection in 31. The histological types of tumors were DCIS (77.3%) and DCIS with a microinvasion (22.7%). While the conventional pathologic examination showed axillary metastasis in 2 of 151 patients (1.3%) with an axillary dissection, serial sectioning and immunohistochemical staining for cytokeratin on the sentinel node in 27 patients revealed 2 more patients with a micrometastasis that were found to be negative in a conventional pathological examination.
CONCLUSION
The serial sectioning and immunohistochemical method for the sentinel LNs of patients with DCIS and DCIS-M are superior to a conventional histological examination for detecting a metastatic carcinoma. The patients with a micrometastasis might be considered as a high risk group and a close long-term follow up would be required to define their prognostic significance.