Axillary Staging Outcomes in Women Undergoing Mastectomy for Ductal Carcinoma in Situ in the Era of Gene Expression assays.

Document Type

Article

Publication Date

12-2025

Publication Title

Surgery

Abstract

BACKGROUND: Approximately 20% of women diagnosed with ductal carcinoma in situ on core biopsy will be upstaged to invasive disease on final pathology. Sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ is the current standard of care. However, the underlying invasive cancer is frequently of low grade with favorable biology, bringing into question the necessity of sentinel lymph node biopsy to help guide clinical treatment recommendations. The primary study objective was to determine how often sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ alters adjuvant therapy recommendations.

METHODS: A single-institution cancer registry retrospectively identified women treated with mastectomy for a preoperative diagnosis of ductal carcinoma in situ between November 2017 and November 2023, excluding those with a previous history of ipsilateral breast cancer. The impact of pathologic nodal status on adjuvant treatment was evaluated.

RESULTS: The study population included 175 patients with a total of 38 invasive cancers identified. Of those with pT1 malignancies, 3 had a positive sentinel node. One patient was recommended for additional adjuvant treatment, in the form of radiation therapy, as a result of axillary staging. No patients were recommended for chemotherapy based solely on sentinel lymph node biopsy results.

CONCLUSION: Despite current recommendations to perform sentinel lymph node biopsy in ductal carcinoma in situ treated with mastectomy in the event invasive cancer is identified on final pathology, our outcomes suggest nodal status has limited impact on adjuvant therapy offerings. These findings indicate that sentinel lymph node biopsy may not be requisite for every patient undergoing mastectomy for ductal carcinoma in situ.

First Page

109909

Last Page

109909

DOI

10.1016/j.surg.2025.109909

ISSN

1532-7361

PubMed ID

41353075

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