Table F25Treatment utilization and patient outcomes in relation to sentinel node biopsy in patients with DCIS

Author, Country, Source of DataN Positive Sentinel NodesDefinition of the OutcomePatients
Intra, 2008126
Country: Italy
Source: The European Institute of Oncology
12Adjuvant treatmentAll 12 patients with positive SLN and 3 patients with ITC in the SLN received adjuvant treatment: endocrine therapy alone was offered to 9 patients and chemotherapy alone to 6 patients.
Intra, 2008126
Country: Italy
Source: The European Institute of Oncology
12RadiotherapyAll 11 patients who had undergone breast conservative surgery received complementary radiotherapy to the breast at the standard dose
Murphy, 2008 Murphy, 2008 #3553}
Country: USA
Source: Medical records in the Division of Surgical Oncology, Brigham and Women’s Hospital, Boston, MA
N/RRecurrences were identified by chart review. Local recurrences were defined as in-breast recurrence after breast conservation, chest wall recurrence after mastectomy, or recurrence within the axilla. All other recurrences were considered distant.Seven positive SNB patients had completion axillary lymph node dissections, and no additional positive nodes were revealed. 2 patients who underwent mastectomy received chest wall radiation, 1 for a focally positive posterior margin.
Intra, 2003127
Country: Italy
Source: The European Institute of Oncology
7RadiotherapyAll patients whose SLN was positive for metastases, except for 1 who underwent a mastectomy, underwent standard external radiotherapy (5000 rad [50 Gy] to the whole breast and 1000 rad [10 Gy] as a boost to the tumor bed. The other 216 patients whose SLNs were negative for metastases underwent external radiotherapy only in case of high-grade DCIS.
7Adjuvant treatmentAll 7 patients whose SLNs were positive for metastases were examined for adjuvant therapy according to the main predictive and prognostic factors. Adjuvant therapy for these patients was as follows: patients 1 and 3, a combination of doxorubicin hydrochloride (Adriamycin) and cyclophosphamide for 4 cycles and a combination of cyclophosphamide, methotrexate, and fluorouracil for 3 cycles; patients 2 and 7, tamoxifen citrate; patient 4, a luteinizing hormone–releasing hormone analogue; patient 5, tamoxifen citrate and a luteinizing hormone– releasing hormone analogue; and patient 6, a combination of cyclophosphamide, methotrexate, and fluorouracil for 3 cycles and tamoxifen citrate.
7Complete axillary dissection during a second sessionAll patients with DCIS, except for 1 with a metastatic SLN, underwent a complete axillary dissection during a second session. One patient with 1 micrometastatic SLN and 3 other first-level nonmetastatic nodes, informed about the risks, refused complete axillary dissection
Huo, 2006128
Country: USA
Source: The University of Texas M. D. Anderson Cancer Center
3Axillary lymph node dissectionAll 3 patients with positive SNB underwent a completion axillary lymph node dissection
Polom, 2008129
Country: Poland
Source: 1st Department of Oncological and General Surgery, Wielkopolska Cancer Centre
2Axillary lymph node dissectionAll 2 patients with metastases to the sentinel node underwent axillary lymphadenectomy
Dominguez, 2008130
Country: USA
Source: Massachusetts General Hospital and Brigham and Women s Hospital, in Boston, Massachusetts
16Axillary lymph node dissectionThree patients underwent ALND on the basis of positive SNBs and in each the SNB was the only positive node. Eighteen of 19 patients with unsuspected invasive cancer were able to avoid axillary dissection on the basis of SNB results
Dominguez, 2008130
Country: USA
Source: Massachusetts General Hospital and Brigham and Women s Hospital, in Boston, Massachusetts
16Adjuvant treatmentSeven patients (37%) received adjuvant chemotherapy, including two patients found to have an ipsilateral invasive carcinoma and two patients who had a contralateral synchronous invasive breast cancer. Only two patients received chemotherapy as a result of a positive sentinel node with only DCIS identified in the breast. Twelve out of 19 patients (63%) with a positive sentinel node received hormonal therapy with tamoxifen or an aromatase inhibitor
Mabry, 2006131
Country: USA
Source: USC/Norris Cancer Center and the Van Nuys Breast Center
10Adjuvant treatmentNone of the IHC-positive patients were treated with chemotherapy
Tunon-de-Lara, 2008132
Country: France
Source: 6 French Cancer Centers (Marseille, Lille, Nantes, Rouen, Rennes, and Bordeaux)
6Axillary lymph node dissectionALND was performed in five of the six positive SN patients and none was found positive. The sixth declined recommended axillary dissection
Sakr, 2008133
Country: France
Source: Department of Gynecology; Department of Pathology; and Department of Radiology, Hospital Tenon, Paris, France
9Complete axillary lymph node dissection1 patient with positive SN among pure DCIS and 1 patient with positive SN among DCISM
Yen, 2005134
Country: USA
Source: The University of Texas MD Anderson Cancer Center
14Adjuvant treatmentAmong patients with pure DCIS and positive SN, 1 patient was administered with tamoxifen and anastrozole, one had monotherapy with tamoxifen +chemotherapy, and one had chemotherapy. 1 patient with positive SN among DCISM was treated with anastrozole
Sakr, 2006135
Country: France
Source: Department of Gynecology, Hopital Tenon, Paris, France
9Axillary lymph node dissectionAll 4 patients with positive SN among pure DCIS with pure micropapillary and high-grade DCIS, underwent complete ALND
1 patient with DCISM and positive SN had initial diffuse DCIS and underwent mastectomy with axillary lymph node exploration and second complete ALND
Katz, 2006136
Country: USA
Source: Sibley Memorial Hospital (SMH) in Washington DC
8Axillary lymph node dissectionTwo of 8 patients with positive SLNs (both by H&E) underwent completion axillary dissection, and neither was found to have additional involved axillary nodes.
Adjuvant treatmentNone of the patients with pure DCIS received adjuvant chemotherapy
RecurrenceNone of 8 patients with positive SN had local, distant, or regional recurrence
Axillary lymph node dissectionOne of 6 patients with a positive SLN among high risk group underwent completion axillary dissection and was not found to have additional positive axillary nodes
One patient with a positive SLN on H&E staining among those that had mastectomy underwent a completion axillary dissection and did not have any additional involved axillary nodes
The patient with the positive SLN by H&E staining among those with DCISM had a 3-mm SLN metastasis and was found to have 1 of 10 involved additional nodes on completion axillary dissection. The other patient had a micrometastasis and did not undergo completion axillary dissection
Adjuvant treatmentThe patient with microinvasive breast cancer, a 3-mm SLN metastasis, and an additional node on completion axillary dissection received adjuvant chemotherapy.
RecurrenceNone of 2 patients with DCISM and positive SN experienced a local, regional, or distant recurrence of breast cancer
Klauber-DeMore, 2000137
Country: USA
Source: Memorial Sloan-Kettering Cancer Center
3Axillary lymph node dissectionSix of nine patients with DCIS and three of three with DCISM and positive sentinel nodes had completion axillary dissection; one patient with DCIS had an additional positive node detected by conventional histological analysis
Tan, 2007138
Country: Canada
Source: the University of Toronto Health Network database
7Axillary lymph node dissectionAmong 5 patients with pure DCIS and positive SNB, 2 patients with icrometastases (pN1mi) and underwent axillary lymph node dissection
Adjuvant treatmentFrom 4 patients with pure DCIS and positive SNB, one underwent chemotherapy
RadiationFrom 4 patients with pure DCIS and positive SNB one underwent radiation
Moore, 2007139
Country: USA
Source: John Wayne Cancer Institute (JWCI), Memorial Sloan-Kettering Cancer Center (MSKCC), and the University of Southern California (USC),
43Adjuvant treatment27 from 43 patients with positive SNB received systemic treatment: 9 received chemotherapy alone, 11 received hormone therapy alone, and 7 received chemotherapy and hormonal therapy
Death from hepatic metastases1 patient with positive SNB, high-grade DCIS with necrosis, microinvasion, treated with mastectomy and immediate tissue transfer reconstruction and adjuvant tamoxifen
Veronesi, 2005140
Country: Italy
Source: the European Institute of Oncology in Milan
9Loco-regional r systemic eventsNo events were observed in the nine SLN-positive patients.
Axillary lymph node dissectionEight from none patients with positive SNB underwent complete axillary dissection
Mittendorf, 2005141
Country: USA
Source: the Comprehensive Breast Center at Walter Reed Army Medical Center
9Axillary lymph node dissectionCompletion axillary dissection was performed in 2 patients with pure DICS and positive SNB at the discretion of the attending surgeon, and no additional positive lymph nodes were identified
Adjuvant treatmentOne patient with a sentinel lymph node that was positive for micrometastatic disease by IHC only underwent chemotherapy despite no evidence of invasive disease found in her primary lesion
Gray, 2007142
Country: USA
Source: the Mayo Clinic in Arizona and the cancer registries of the Mayo Clinic sites in Arizona, Jacksonville, and Rochester
6Local, regional, and distant diseaseAll patients were alive and free of local, regional, and distant disease
van la Parra, 2008143
Country: The Netherlands
Source: Department of Surgery, Jeroen Bosch Ziekenhuis, The Netherlands
5Axillary lymph node dissectionAll 5 patients with positive SNB underwent axillary dissection.
No additional positive axillary lymph nodes were found
Local recurrences or systemic metastasesNo local recurrences and no systemic metastases
Camp, 2005144
Country: USA
Source: Departments of Surgery and Pathology, University of Florida
7Axillary lymph node dissectionFour of the seven patients with positive SLNs underwent an axillary dissection and none of these patients was found to have any non-SLN metastases
Zavagno, 2007145
Country: Italy
Source: 6 academic centers in Italy
4Axillary lymph node dissectionAll four patients with positive SLN underwent complete ALND and in all these cases further metastatic axillary nodes were found
Intra, 2003146
Country: Italy
Source: Prospective database in the Department of Surgery, Breast Unit University of Milan School of Medicine; and the Department of Nuclear Medicine and Division of Chemoprevention, European Institute of Oncology, Milan, Italy
4RadiationAll patients submitted to breast-conserving surgery received standard external radiotherapy (50 Gy to the whole breast and 10 Gy as a boost to the tumor bed).
Liu, 2003147
Country: Taiwan
Source: Taichung Veterans General Hospital, Taiwan
3Axillary lymph node dissectionAll patients underwent axillary lymph node dissection, nodes were positive in one woman who had positive SNB and was diagnosed with invasive cancer in final biopsy.
Tamhane, 2002148
Country: Australia
Source: Calvary Hospital and the Australian Capital Territory pathology database
6Mortality or local recurrenceAll patients with DCIS were alive without local recurrence or metastasis
Adjuvant treatmentNo patients with DCIS regardless of SNB status had adjuvant chemotherapy
RadiationNo patients with DCIS regardless of SNB status received radiotherapy after mastectomy
Zavotsky, 1999149
Country: USA
Source: Joyce Eisenberg Keefer Breast Center of the John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California
2Axillary lymph node dissectionCompletion axillary dissection was performed on both patients with positive SNB and did not find further tumor positive lymph node metastases
Guth, 2008150
Country: USA
Source: Department of Pathology data in the NYU School of Medicine
3Axillary lymph node dissectionOne patient had two additional positive lymph nodes on ALND; one did not undergo complete axillary dissection, and the third patient had negative axillary dissection.

From: Appendix F, Evidence Tables

Cover of Diagnosis and Management of Ductal Carcinoma in Situ (DCIS)
Diagnosis and Management of Ductal Carcinoma in Situ (DCIS).
Evidence Reports/Technology Assessments, No. 185.
Virnig BA, Shamliyan T, Tuttle TM, et al.

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