In a multivariate analysis, the JAMA Oncology study authors found that higher-volume surgeons were significantly less likely to perform axillary lymph node evaluation on patients undergoing BCS (relative risk [RR] = 0.54; 95% CI: 0.44-0.64; P < 0.05).1

The study “has shed some light on how the changes in recommended practice have been adopted in a broad sample of hundreds of predominantly small, urban, nonteaching hospitals across the country and by general surgeons who infrequently treat women with DCIS,” Dr. Van Zee wrote.2


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Guidelines from both the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) recommend sentinel lymph bode biopsy accompany mastectomy for staging purposes, but recommend against axillary evaluation in BCS.1,5,6

Nodal evaluation is rarely recommended for women undergoing BCS, except in cases involving excision that precludes subsequent SLNB, core biopsy-diagnosed DCIS of large area, or those with imaging-detected suspect mass, Dr. Van Zee wrote.2

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“Though the use of axillary evaluation in DIS may be appropriate in some cases, the high rates of axillary evaluation indicated that additional research is needed,” Coromilas and coauthors report.

They suggest that in some cases, node markers might be placed rather than excising the lymph node, allowing for followup sentinel node removal when tumor biopsy reveals invasive malignancy.1

“Perhaps more importantly, additional prospective evaluation is needed to determine if there is a clinical benefit to axillary evaluation in women with DCIS,” they conclude.1

References

  1. Coromilas EJ, Wright JD, Huang Y, et al. The influence of hospital and surgeon factors on the prevalence of axillary lymph node evaluation in ductal carcinoma in situ. JAMA Oncol. April 9, 2015 [Epub ahead of print] doi:10.1001/jamaoncol.2015.0389.
  2. Van Zee KJ. Use of axillary staging in the management of ductal carcinoma in situ. JAMA Oncol. April 9, 2015 [Epub ahead of print] doi:10.1001/jamaoncol.2015.0390.
  3. Ponti A, Lynge E, James T, et al. International variation in management of screen-detected ductal carcinoma in situ of the breast. Eur J Cancer. 2014;50(15):2695-2704.
  4. Prendeville S, Ryan C, Feely L, et al. Sentinel lymph node biopsy is not warranted following a core needle biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast. Breast. February 11, 2015 [Epub ahead of print] doi:10.1016/j.breast.2015.01.004.
  5. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practive Guidelines in Oncology. Breast Cancer: Version 1.2015[A11] . National Comprehensive Cancer Network.
  6. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-7720.