Audit on sentinel node positivity following diagnosis of incidental invasive breast cancer on wide local excision (WLE) for ductal carcinoma in situ (DCIS)
Association of Breast Surgery ePoster Library. Mahmoud O. 05/15/17; 166206; P117
Omar Mahmoud
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Abstract
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Introduction:
DCIS comprises of 20% of all new cases of breast cancer. DCIS does not metastasize, therefore axillary exploration is not recommended. Sentinel lymph node (SLN) biopsy omission had no adverse effect on survival or recurrence.
The risk of incidental invasive cancer in patients with DCIS ranges from 5%- 44%. Axillary node metastasis is 1-2 % in large DCIS (>4cm). SLN biopsy is suited for such ''high-risk'' cases.
Association of breast surgery (ABS) guidelines state surgical excision for DCIS. If invasive cancer is found, axillary staging is required. Positive SLN mandates axillary treatment.
Our aim was to identify the incidental cancers in patients having WLE only for DCIS and find proportion of patients with positive SLN or recurrence.
Methods:
A retrospective audit of patients having WLE only for DCIS between 2010-2015. Case notes were reviewed to find the incidence and management of incidental invasive cancers detected following WLE.
Results:
All patients (n=154) with DCIS were treated as per ABS guidelines including those diagnosed with incidental cancer (DCIS confirmed n=120 (78%); incidental invasive cancer, SLN performed n=34 (22 %). SLN positive n=2 (6%) had further axillary treatment. However, all patients with incidental cancer < 5mm had negative SLN (41%). Recurrence was seen in one patient and this patient had only DCIS.
Conclusion:
Incidental invasive cancer (<5mm) is less likely to metastasize and omitting SLN biopsy can be a safe option. Alternatively a low recurrence score on Oncotype Dx assay could be used for incidental small invasive focus (ER+) rather than a second surgery for SLN.
DCIS comprises of 20% of all new cases of breast cancer. DCIS does not metastasize, therefore axillary exploration is not recommended. Sentinel lymph node (SLN) biopsy omission had no adverse effect on survival or recurrence.
The risk of incidental invasive cancer in patients with DCIS ranges from 5%- 44%. Axillary node metastasis is 1-2 % in large DCIS (>4cm). SLN biopsy is suited for such ''high-risk'' cases.
Association of breast surgery (ABS) guidelines state surgical excision for DCIS. If invasive cancer is found, axillary staging is required. Positive SLN mandates axillary treatment.
Our aim was to identify the incidental cancers in patients having WLE only for DCIS and find proportion of patients with positive SLN or recurrence.
Methods:
A retrospective audit of patients having WLE only for DCIS between 2010-2015. Case notes were reviewed to find the incidence and management of incidental invasive cancers detected following WLE.
Results:
All patients (n=154) with DCIS were treated as per ABS guidelines including those diagnosed with incidental cancer (DCIS confirmed n=120 (78%); incidental invasive cancer, SLN performed n=34 (22 %). SLN positive n=2 (6%) had further axillary treatment. However, all patients with incidental cancer < 5mm had negative SLN (41%). Recurrence was seen in one patient and this patient had only DCIS.
Conclusion:
Incidental invasive cancer (<5mm) is less likely to metastasize and omitting SLN biopsy can be a safe option. Alternatively a low recurrence score on Oncotype Dx assay could be used for incidental small invasive focus (ER+) rather than a second surgery for SLN.
Introduction:
DCIS comprises of 20% of all new cases of breast cancer. DCIS does not metastasize, therefore axillary exploration is not recommended. Sentinel lymph node (SLN) biopsy omission had no adverse effect on survival or recurrence.
The risk of incidental invasive cancer in patients with DCIS ranges from 5%- 44%. Axillary node metastasis is 1-2 % in large DCIS (>4cm). SLN biopsy is suited for such ''high-risk'' cases.
Association of breast surgery (ABS) guidelines state surgical excision for DCIS. If invasive cancer is found, axillary staging is required. Positive SLN mandates axillary treatment.
Our aim was to identify the incidental cancers in patients having WLE only for DCIS and find proportion of patients with positive SLN or recurrence.
Methods:
A retrospective audit of patients having WLE only for DCIS between 2010-2015. Case notes were reviewed to find the incidence and management of incidental invasive cancers detected following WLE.
Results:
All patients (n=154) with DCIS were treated as per ABS guidelines including those diagnosed with incidental cancer (DCIS confirmed n=120 (78%); incidental invasive cancer, SLN performed n=34 (22 %). SLN positive n=2 (6%) had further axillary treatment. However, all patients with incidental cancer < 5mm had negative SLN (41%). Recurrence was seen in one patient and this patient had only DCIS.
Conclusion:
Incidental invasive cancer (<5mm) is less likely to metastasize and omitting SLN biopsy can be a safe option. Alternatively a low recurrence score on Oncotype Dx assay could be used for incidental small invasive focus (ER+) rather than a second surgery for SLN.
DCIS comprises of 20% of all new cases of breast cancer. DCIS does not metastasize, therefore axillary exploration is not recommended. Sentinel lymph node (SLN) biopsy omission had no adverse effect on survival or recurrence.
The risk of incidental invasive cancer in patients with DCIS ranges from 5%- 44%. Axillary node metastasis is 1-2 % in large DCIS (>4cm). SLN biopsy is suited for such ''high-risk'' cases.
Association of breast surgery (ABS) guidelines state surgical excision for DCIS. If invasive cancer is found, axillary staging is required. Positive SLN mandates axillary treatment.
Our aim was to identify the incidental cancers in patients having WLE only for DCIS and find proportion of patients with positive SLN or recurrence.
Methods:
A retrospective audit of patients having WLE only for DCIS between 2010-2015. Case notes were reviewed to find the incidence and management of incidental invasive cancers detected following WLE.
Results:
All patients (n=154) with DCIS were treated as per ABS guidelines including those diagnosed with incidental cancer (DCIS confirmed n=120 (78%); incidental invasive cancer, SLN performed n=34 (22 %). SLN positive n=2 (6%) had further axillary treatment. However, all patients with incidental cancer < 5mm had negative SLN (41%). Recurrence was seen in one patient and this patient had only DCIS.
Conclusion:
Incidental invasive cancer (<5mm) is less likely to metastasize and omitting SLN biopsy can be a safe option. Alternatively a low recurrence score on Oncotype Dx assay could be used for incidental small invasive focus (ER+) rather than a second surgery for SLN.
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