The American Society of Breast Surgeons
Do sentinel node micrometastases predict recurrence risk
in ductal carcinoma in situ and ductal carcinoma in situ
Colleen D. Murphy, M.D.
*, Julie L. Jones, M.D.
, Sara Hughes Javid, M.D.
James S. Michaelson, Ph.D.
, Matthew E. Nolan, A.B.
, Stuart R. Lipsitz, Sc.D.
Michelle C. Specht, M.D.
, Beth-Ann Lesnikoski, M.D.
, Kevin S. Hughes, M.D.
Michele A. Gadd, M.D.
, Barbara L. Smith, M.D., Ph.D.
Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA;
Division of Surgical Oncology,
Brigham and Women’s Hospital, Boston, MA, USA;
Departments of Medicine and Surgery, Brigham and Women’s
Hospital, Boston, MA
BACKGROUND: Because the implications of micrometastases found on sentinel node biopsy (SNB)
for ductal carcinoma in situ (DCIS) or ductal carcinoma in situ with microinvasion (DCISM) are largely
unknown, we wished to determine if SNB pathology predicted recurrence risk in DCIS/DCISM.
METHODS: Retrospective chart review identiﬁed patients with DCIS/DCISM who underwent SNB.
SNB ﬁndings and all local and distant recurrences were determined.
RESULTS: A total of 322 patients underwent SNB for DCIS/DCISM. There were 13 local recurrences
(4.0%) and 1 (.03%) distant recurrence at a median follow-up of 47.9 months (range 0 to 110.6), 12 in
patients with negative SNBs; 1 patient had a positive SNB. There were 4 recurrences after mastectomy and
9 after lumpectomy. In 29 patients with positive SNBs, there was only 1 recurrence (3.4%).
CONCLUSIONS: Positive SNBs in patients with DCIS or DCISM are not associated with higher risk of
local or distant recurrence. Other features of DCIS and DCISM may be important in predicting recurrence risk.
© 2008 Elsevier Inc. All rights reserved.
in situ with
Sentinel lymph node
Sentinel node biopsy (SNB) has been well validated for
staging invasive breast cancer with low rates of axillary
Some investigators have recommended routine
SNB for ductal carcinoma in situ (DCIS) or ductal carci-
noma in situ with microinvasion (DCISM) because 8% to
12% of these patients are found to have nodal metastases on
, and 10% to 20%
of patients with DCIS are upstaged
to invasive disease at deﬁnitive surgery. Because there are
little data on the long-term implications of such SNB me-
tastases, and because local recurrence rates for DCIS are
higher than for invasive disease, we wished to determine if
SNB pathology predicted local recurrence risk in patients
with DCIS or DCISM.
Patients and Methods
Institutional Review Board–approved chart review iden-
tiﬁed 322 patients with DCIS or DCISM on ﬁnal pathology
who underwent SNB from 1997 to 2003. SNB was per-
* Corresponding author. Tel.: ϩ1-617-724-1074; fax: ϩ1-617-724-1079.
E-mail address: email@example.com
Manuscript received April 16, 2008; revised manuscript June 4, 2008
0002-9610/$ - see front matter © 2008 Elsevier Inc. All rights reserved.
The American Journal of Surgery (2008) 196, 566–568