수술 전 관상피내암으로 진단된 환자에서의 감시림프절 생검을 고려해야 하는 위험인자들에 대한 고찰
Risk Factors Associated with Sentinel Lymph Node Biopsy in Patients with a Preoperative Diagnosis of Ductal Carcinoma In Situ
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Sentinel lymph node (SLN) biopsy has become the gold standard for axillary staging of invasive breast cancer. However, some controversy has existed concerning the usefulness of SLN biopsy in ductal carcinoma in situ (DCIS). In this study, we tried to identify the usefulness of SLN biopsy in patients with an initial preoperative diagnosis of DCIS. Methods: A retrospective analysis was performed using single-center data of 415 patients with an initial diagnosis of DCIS between January 2003 and December 2013. Many features were correlated with upstaging and positive SLN biopsy using univariate analysis and multivariate analysis. Results: A total of 415 patients with a preoperative diagnosis of DCIS were enrolled in this study. Total 320 of 415 patients (77.1%) underwent axillary evaluation via SLN biopsy, axillary lymph node dissection, or additional axillary lymph node dissection, and 24 of 320 patients (7.5%) were diagnosed with axillary lymph node metastasis or micrometastases in the lymph nodes. Of 415, 296 patients (71.3%) underwent SLN biopsy and 16 patients (5.4%) had positive SLN biopsy. The rate of upstaging to invasive cancer was 4.1% (17 of 415 patients) on final pathology. Of the 17 patients who were upstaged to invasive carcinoma at final pathology, seven patients (41.2%) had a positive SLN biopsy. The statistically significant factors of upstaging were large tumor size (≥2 cm), histologic features of intermediate or high-grade tumor, and positive SLN biopsy. Conclusion: SLN biopsy should be considered in patients with high risk DCIS as a part of the primary surgical procedure.
Abstract
Purpose: Sentinel lymph node (SLN) biopsy has become the gold standard for axillary staging of invasive breast cancer. However, some controversy has existed concerning the usefulness of SLN biopsy in ductal carcinoma in situ (DCIS). In this study, we tried to identify the usefulness of SLN biopsy in patients with an initial preoperative diagnosis of DCIS. Methods: A retrospective analysis was performed using single-center data of 415 patients with an initial diagnosis of DCIS between January 2003 and December 2013. Many features were correlated with upstaging and positive SLN biopsy using univariate analysis and multivariate analysis. Results: A total of 415 patients with a preoperative diagnosis of DCIS were enrolled in this study. Total 320 of 415 patients (77.1%) underwent axillary evaluation via SLN biopsy, axillary lymph node dissection, or additional axillary lymph node dissection, and 24 of 320 patients (7.5%) were diagnosed with axillary lymph node metastasis or micrometastases in the lymph nodes. Of 415, 296 patients (71.3%) underwent SLN biopsy and 16 patients (5.4%) had positive SLN biopsy. The rate of upstaging to invasive cancer was 4.1% (17 of 415 patients) on final pathology. Of the 17 patients who were upstaged to invasive carcinoma at final pathology, seven patients (41.2%) had a positive SLN biopsy. The statistically significant factors of upstaging were large tumor size (≥2 cm), histologic features of intermediate or high-grade tumor, and positive SLN biopsy. Conclusion: SLN biopsy should be considered in patients with high risk DCIS as a part of the primary surgical procedure.
참고문헌 (23)
- Francis AM, "Is sentinel lymph node dissection warranted for patients with a diagnosis of ductal carcinoma in situ?", Ann Surg Oncol, 22, pp.4270~4279 (2015)
- Boxer MM, "A review of the management of ductal carcinoma in situ following breast conserving surgery", Breast, 22, pp.1019~1025 (2013)
- Mokbel K, "Towards optimal management of ductal carcinoma in situ of the breast", Eur J Surg Oncol, 29, pp.191~197 (2003)
- Mabry H, "What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ?", Am J Surg, 192, pp.455~457 (2006)
- Kim J, "Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision", Breast, 21, pp.641~645 (2012)
- Gradishar WJ, "Breast cancer version 2.2015", J Natl Compr Canc Netw, 13, pp.448~475 (2015)
- Meijnen P, "Changing patterns in diagnosis and treatment of ductal carcinoma in situ of the breast", Eur J Surg Oncol, 31, pp.833~839 (2005)
- 김지선, "The Basic Facts of Korean Breast Cancer in 2011: Results of a Nationwide Survey and Breast Cancer Registry Database", Journal of Breast Cancer, 17(2), pp.99~106 (2014), 한국유방암학회
- Virnig BA, "Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes", J Natl Cancer Inst, 102, pp.170~178 (2010)
- Intra M, "Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast: the experience of the European institute of oncology on 854 patients in 10 years", Ann Surg, 247, pp.315~319 (2008)
- Cox CE, "Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS?", Am Surg, 67, pp.513~519 (2001)
- Ansari B, "Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast", Br J Surg, 95, pp.547~554 (2008)
- van Deurzen CH, "Is there an indication for sentinel node biopsy in patients with ductal carcinoma in situ of the breast? A review", Eur J Cancer, 43, pp.993~1001 (2007)
- Ko E, "Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy", Breast Cancer Res Treat, 112, pp.189~195 (2008)
- Lee JW, "Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus", J Surg Oncol, 98, pp.15~20 (2008)
- Pendas S, "Sentinel node biopsy in ductal carcinoma in situ patients", Ann Surg Oncol, 7, pp.15~20 (2000)
- Wilkie C, "An update of sentinel lymph node mapping in patients with ductal carcinoma in situ", Am J Surg, 190, pp.563~566 (2005)
- Zavagno G, "Sentinel lymph node metastasis from mammary ductal carcinoma in situ with microinvasion", Breast, 16, pp.146~151 (2007)
- Zetterlund L, "Incidence of and risk factors for sentinel lymph node metastasis in patients with a postoperative diagnosis of ductal carcinoma in situ", Br J Surg, 101, pp.488~494 (2014)
- Silverstein MJ, "Predicting axillary node positivity in patients with invasive carcinoma of the breast by using a combination of T category and palpability", J Am Coll Surg, 180, pp.700~704 (1995)
- Sakr R, "Ductal carcinoma in situ: value of sentinel lymph node biopsy", J Surg Oncol, 94, pp.426~430 (2006)
- Miyake T, "Indication for sentinel lymph node biopsy for breast cancer when core biopsy shows ductal carcinoma in situ", Am J Surg, 202, pp.59~65 (2011)
- 이희재, "관상피내암으로 최초 진단된 환자에서의 수술 후 잔존 침윤성 유방암의 예측인자 및 감시림프절 검사의 적용", 대한외과학회지, 79(6), pp.436~441 (2010), 대한외과학회