Pro: SLNB in DCIS

Excerpt

The role of sentinel node mapping and biopsy in the management of ductal carcinoma in situ (DCIS) remains controversial. A debate about the use of a staging technique for the evaluation of a malignancy without metastatic potential seems absurd. However, this debate is fueled by two factors. First, some patients diagnosed with DCIS will ultimately prove to have invasive carcinoma. Second, the status of the sentinel node is the most powerful predictor of prognosis and surgeons want to ensure that those patients with invasive carcinoma have sentinel node mapping for staging and treatment planning. In order to understand this debate an appreciation of the evolution of breast cancer management over the past decade is essential. The two most important historical events in this evolution have been the appreciation of the relationship of prior lumpectomy and its impact on lymphatic drainage from the breast to the sentinel node, and the increasing use of image guided core needle breast biopsies to sample mammographic abnormalities that may underestimate the extent of breast pathology. …