Location
LSU Health Sciences Center - New Orleans
Event Website
https://www.medschool.lsuhsc.edu/genetics/2024_medical_student_research_poster_symposium.aspx
Presentation Date
5-11-2024 11:30 AM
Description
BACKGROUND: Ductal Carcinoma In-Situ (DCIS) is a non-invasive neoplastic proliferation of breast ductal epithelial cells confined to the ductal-lobular system. Currently, DCIS is classified by nuclear grade (low, intermediate, high) based on nuclear features and necrosis. Untreated DCIS increases a woman’s risk of developing invasive breast cancer in the same breast tenfold. Thus, when found on a breast biopsy, DCIS warrants further surgical resection and margin examination via lumpectomy (partial mastectomy). Despite High-Grade DCIS carrying a higher risk for finding associated invasive carcinoma upon resection, it remains controversial whether sentinel lymph-node dissection is indicated during initial breast resection.
OBJECTIVES: The purpose of this study is to investigate the necessity of performing axillary lymph node dissections with lumpectomy (partial mastectomy) in patients with biopsy-proven high-grade Ductal Cell In-Situ (DCIS).
METHODS: Medical records were reviewed of patients who underwent partial mastectomy with biopsy-proven high-grade DCIS (with or without sentinel lymph node biopsy) during the time period of August 2017- April 2024. Cases of biopsy-proven Invasive Ductal Carcinoma with associated DCIS (IDC + DCIS) were used as controls. The collected patient data was stored under a secure study ID number. A chi-squared analysis was conducted with a significance level of α = 0.05.
RESULTS: A total of 77 DCIS cases were reviewed: 9 low-grade (LG), 31 intermediate-grade (IG), and 37 high-grade (HG). The control group included 74 cases of IDC + DCIS. Despite sentinel lymph node biopsies being performed in 75.7% of HG-DCIS group. There was no significant difference in metastasis compared to IG-DCIS group (5.4% vs 3.2%, p>0.05). However, HG-DCIS group showed a significantly lower rate of metastatic lymph nodes than the control group (5.4% vs. 34.5%, p<0.01). No patients within the LG-DCIS group had lymph node metastasis, although only 4 cases of lymph-node biopsy were recorded. ER positivity was significantly lower in HG-DCIS group compared to LG- and IG-DCIS groups (p<0.01), but was similar to the control group (p>0.05). Both patients with metastatic cancer in HG-DCIS group had significant family histories of breast cancer.
CONCLUSIONS: Sentinel lymph node biopsy was frequently performed in patients with HGDCIS, although the frequency of sentinel lymph node metastasis was low (p<0.01). These findings suggest that sentinel lymph node biopsy may not be indicated for all patients with HGDCIS. However, factors such as abnormal breast imaging and family history of breast cancer should be considered.
Recommended Citation
Herbert, Carson, "Examining the necessity of axillary lymph node dissection with lumpectomy in biopsy-proven high-grade DCIS" (2024). Medical Student Research Poster Symposium. 48.
https://digitalscholar.lsuhsc.edu/sommrd/2024MSRD/Posters/48
Included in
Examining the necessity of axillary lymph node dissection with lumpectomy in biopsy-proven high-grade DCIS
LSU Health Sciences Center - New Orleans
BACKGROUND: Ductal Carcinoma In-Situ (DCIS) is a non-invasive neoplastic proliferation of breast ductal epithelial cells confined to the ductal-lobular system. Currently, DCIS is classified by nuclear grade (low, intermediate, high) based on nuclear features and necrosis. Untreated DCIS increases a woman’s risk of developing invasive breast cancer in the same breast tenfold. Thus, when found on a breast biopsy, DCIS warrants further surgical resection and margin examination via lumpectomy (partial mastectomy). Despite High-Grade DCIS carrying a higher risk for finding associated invasive carcinoma upon resection, it remains controversial whether sentinel lymph-node dissection is indicated during initial breast resection.
OBJECTIVES: The purpose of this study is to investigate the necessity of performing axillary lymph node dissections with lumpectomy (partial mastectomy) in patients with biopsy-proven high-grade Ductal Cell In-Situ (DCIS).
METHODS: Medical records were reviewed of patients who underwent partial mastectomy with biopsy-proven high-grade DCIS (with or without sentinel lymph node biopsy) during the time period of August 2017- April 2024. Cases of biopsy-proven Invasive Ductal Carcinoma with associated DCIS (IDC + DCIS) were used as controls. The collected patient data was stored under a secure study ID number. A chi-squared analysis was conducted with a significance level of α = 0.05.
RESULTS: A total of 77 DCIS cases were reviewed: 9 low-grade (LG), 31 intermediate-grade (IG), and 37 high-grade (HG). The control group included 74 cases of IDC + DCIS. Despite sentinel lymph node biopsies being performed in 75.7% of HG-DCIS group. There was no significant difference in metastasis compared to IG-DCIS group (5.4% vs 3.2%, p>0.05). However, HG-DCIS group showed a significantly lower rate of metastatic lymph nodes than the control group (5.4% vs. 34.5%, p<0.01). No patients within the LG-DCIS group had lymph node metastasis, although only 4 cases of lymph-node biopsy were recorded. ER positivity was significantly lower in HG-DCIS group compared to LG- and IG-DCIS groups (p<0.01), but was similar to the control group (p>0.05). Both patients with metastatic cancer in HG-DCIS group had significant family histories of breast cancer.
CONCLUSIONS: Sentinel lymph node biopsy was frequently performed in patients with HGDCIS, although the frequency of sentinel lymph node metastasis was low (p<0.01). These findings suggest that sentinel lymph node biopsy may not be indicated for all patients with HGDCIS. However, factors such as abnormal breast imaging and family history of breast cancer should be considered.
https://digitalscholar.lsuhsc.edu/sommrd/2024MSRD/Posters/48
Comments
Mentor: Dr. Zhiyan Fu, MD, MS LSUHSC, Department of Pathology