Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital

Rafael da Silva Sá,1,2 Angela Flávia Logullo,3 Simone Elias,1 Gil Facina,1 Vanessa Monteiro Sanvido,1 Afonso Celso Pinto Nazário1 1Department of Gynaecology, Breast Surgery Team, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; 2Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil; 3Department of Pathology, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilCorrespondence: Rafael da Silva SáDepartment of Gynaecology, Breast Surgery Team, Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa, 249, São Paulo, SP, CEP 04020-060, BrazilTel +55 11 55764848Email rafasamed@hotmail.comBackground: Mammography screening has become widely spread and provided a marked increase in ductal carcinoma in situ (DCIS) diagnosis. In DCIS, the ductal epithelium proliferates without invasion through the basal cell membrane. However, histologic underestimation can happen in some cases.Objective: To analyze the rate of histologic underestimation (histopathologic results upgraded to invasive carcinoma after surgery) and the rate of positive results of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS in a Brazilian public hospital.Methods: We reviewed medical records of all consecutive patients admitted between 2009 and 2013 whose initial diagnosis was DCIS through core needle biopsy. DCIS cases with a high risk of invasion underwent SLNB. We excluded cases with invasion or micro-invasion components in the first biopsy.Results: A total of 86 women were included, most with microcalcifications as the primary radiological lesion (73.2%), and underwent preoperative biopsy, with an invasive component in 21 (24.4%) in the final pathology report. Most had invasive carcinoma of no special type (NST): 52.3% (n = 11) and microinvasive tumors (7 cases, 33.3%). The main factors associated with histologic underestimation were nodular lesion (61.9%, p< 0.001) and an ultra-sonography-guided biopsy (71.4%, p=0.0005). The positivity rate of SLNB was 4.3%. All these patients underwent mastectomy, and the initial histologic pattern was solid DCIS.Conclusion: The “histologic underestimation” rate among patients with DCIS was not low, and less than 5% of patients who underwent SLNB had axillary positivity. This result suggests that patients who have DCIS and a high risk of invasion and undergoing mastectomy should have SLNB. As to the patients who will undergo lumpectomy, SLNB could be omitted and could be performed if patients have upgraded to invasive breast cancer.Keywords: breast cancer, ductal carcinoma in situ, underestimation rates, positive sentinel lymph nod