Nodal Status in the Treatment of Ductal Carcinoma in situ
Dear OncoLink "Ask the Experts,"
I have a question regarding invasive ductal carcinoma in-situ (DCIS).
I was first diagnosed with what my physicians assumed was DCIS, after my mammogram showed numerous calcifications. I had a biopsy, decided on a double mastectomy and reconstruction. When they went to do the mastectomy they found an invasive section that measured 0.5cm with clean margins, well differentiated. The part that bothers me is that they did not check the nodes. Assuming it was DCIS and turning out to be Invasive DCIS, should the nodes be checked or left alone? I have had 8 rounds of CMF and am now on Tamoxifen.
What is your opinion on this? Your comment would be appreciated.
Thanks for your help.
Li Liu, MD, OncoLink Editorial Assistant, responds:
Thank you for your interest and question.
Ductal carcinoma in-situ itself is not invasive and therefore the term "invasive ductal carcinoma in-situ" is somewhat inconsistent. It appears you had DCIS on biopsy, but a small area of invasive disease was picked up only after a mastectomy had been performed. If your breast cancer had been found to be invasive prior to the mastectomy, it would have been reasonable to perform an axillary dissection. Axillary dissection in patients with tumors 0.5cm or less (stage T1a) remains controversial. Silverstein MJ, et al. reported positive axillary lymph nodes in only 3 of 96 patients with T1a breast cancer (Cancer 1994; 73:664-667).
Once a simple mastectomy has been performed and invasive disease is discovered incidentally, some physicians may wish to perform additional axillary surgery and others may with to proceed with chemotherapy. Once you have undergone chemotherapy, the utillity of axillary dissection is unknown.
An alternative to complete axillary dissection is a "sentinel node biopsy". A sentinel lymph node is the first lymph node along the route of lymphatic drainage from a primary tumor. Sentinel node biopsy is an investigational technique to determine the status of the axillary lymph nodes without performing a full axillary dissection. However, the accuracy of sentinel lymph node biopsy varies according to the surgeons and the characteristics of the patients.
It is very important for you to follow up with your doctors on the regular basis.
Best of luck to you.