Surgical Innovations

More news for women with DCIS

In recent years, surgeons have recommended sentinel node biopsy to patients with a non-invasive breast cancer called DCIS (ductal carcinoma in situ). The idea was to remove the lymph nodes closest to the tumor, then check to see if any cancer cells were present. If these nodes tested positive in the pathology lab, the patient faced another round of surgery to remove additional nodes under the armpit. An oncologist might then recommend chemotherapy or hormonal treatment, or both. All of these things were done with the goal of keeping the patient cancer-free and giving her the best possible outcome. But researchers at New York-Presbyterian and Columbia University Medical Center have asked the $64,000 question: Does this approach really help?

Mahmoud B. El-Tamer, MD, Associate Professor of Clinical Surgery and Director of the Breast Fellowship Program, followed the progress of DCIS patients who had their axillary nodes removed in the customary way. All nodes that were considered tumor-free by the conventional methods of staining, were reexamined using newer methods. In this study, the incidence of finding foreign cancer cells in the axillary lymph nodes increased by six percent. Yet a finding of positive cells in the lymph nodes had no long-term effect on the patients' life expectancy. The bottom line, says Dr. El-Tamer, is that most women with DCIS will not benefit from this approach.

As a result of El-Tamer's work, the practice of assessing axillary lymph nodes in women with DCIS has been reconsidered. "The old staining methods showed positive nodes in one percent of these cases," adds Dr. El-Tamer. "We now have much more precise ways to identify abnormal cells that have spread to the lymph nodes. Some studies have found positive nodes in 23 percent of DCIS patients. But our research shows that these cells will have no impact on the woman's long-term survival."

"Our goal is always the safety of the patient," says Dr. El-Tamer. "We believe that sentinel node biopsy surgery should be reserved for a limited group of DCIS patients." Sentinel node biopsies should not be routinely performed on all women with DCIS, Dr. El-Tamer notes. It may lead to over-treatment and may also result in unnecessary trauma for the patient.

Finding even one cancer cell in the lymph nodes is significant if a woman has invasive breast disease, however. When treating DCIS patients, sentinel node biopsy should be reserved for those with any question of invasive disease, those with a palpable lump, and those with extensive DCIS that may require removal of the entire breast.