In cases where DCIS patients undergo TM without SLNB, it would be prudent to perform axillary staging via AD if pathological examination reveals invasive cancer. According to the recommendations of the Korean Breast Cancer Society and National Comprehensive Cancer Network, patients diagnosed with DCIS do not need axillary surgery if they plan to undergo breast-conserving surgery (BCS) conversely, patients who plan to undergo total mastectomy (TM) are strongly recommended to undergo axillary evaluation using SLNB because additional SLNB cannot be performed after TM. Guidelines recommend axillary evaluation based on the type of breast surgery in DCIS patients scheduled for curative surgery. Therefore, SLNB must be used only where necessary to avoid over-treatment, which can cause unnecessary morbidity. SLNB is performed to reduce the complications caused by unnecessary axillary dissection (AD) however, it can also result in additional shoulder pain, sensory disturbance, lymphedema, and limited arm movement. They may proceed with SLNB during primary surgery to minimise the possibility of reoperation and missing true sentinel lymph nodes (SLNs) in the second procedure. Individual surgeons or institutions may have different rationales for sentinel lymph node biopsy (SLNB) depending on the above-mentioned characteristics. Factors associated with upstaging include palpability, tumour size ≥ 5 cm, ultrasonic mass-forming lesions, Van Nuys Classification III, and tumours located in the upper-outer quadrant. Nevertheless, it is estimated that 13.3–37.9% of patients with a preoperative histological diagnosis of DCIS are upgraded to invasive carcinoma on final postoperative histological examination. The incidence of axillary lymph node metastasis in pure ductal carcinoma in situ (DCIS) is < 1% therefore, in principle, pure DCIS patients do not need to undergo axillary surgery, yet unnecessary axillary surgeries are performed too often. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. DCIS diagnosed by core-needle biopsy (odds ratio : 6.861, 95% confidence interval : 2.429–19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224–6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197–8.323) were found to be associated with upstaging. The rate of upstaging to invasive cancer was 19.2% (59/307). Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 20. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS).
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