Is axillary surgery still justified in DCIS diagnosed via vacuum-assisted biopsy?
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ramos Marcellus do Nascimento Moreira, Mattar André, Antonini Marcelo, Zerwes Felipe, Cavagna Felipe, Cavalcante Francisco Pimentel, Millen Eduardo Camargo, Brenelli Fabricio Palermo, Luiz Frasson Antonio, Madeira Marcelo, Amorim Andressa Gonçalves, Teixeira Marina Diógenes, de Figueiredo Marina Fleury, de Oliveira Larissa Chrispim, Sorares Leonardo Ribeiro, Facina Gil, Fenile Rogerio, de Freitas Júnior Ruffo, Arakelian Renata, Dos Santos Marcela Bonalumi, Couto Henrique Lima, Leite Renata Montarroyos, Gomes Pedro Paulo de Andrade, Gomes Gabriela de Oliveira, Gebrim Luiz Henrique, Lopes Reginaldo Guedes Coelho, Real Juliana Monte
Аннотация
METHODS: A retrospective cohort of 494 patients with pure DCIS diagnosed by VAB (2011-2019) was analyzed. Patients were stratified by age, nuclear grade, comedonecrosis, and surgical approach (breast-conserving surgery [BCS] vs. mastectomy). Axillary management included sentinel node biopsy (SNB), axillary dissection (AD), or omission. Multivariate logistic regression identified predictors of axillary surgery and upstaging to invasive carcinoma.
RESULTS: Most patients underwent BCS (72.7%), with axillary evaluation performed in 35.1% of BCS cases versus 91.9% of mastectomies (p < 0.001). Only 3.8% (19/494) were upstaged to invasive carcinoma, and nodal involvement occurred in 1.2% (3/250) of axillary procedures-all in patients with invasive foci on final pathology. No pure DCIS cases had nodal metastasis. Younger age (< 40 years, p = 0.039), high nuclear grade (grade 3, p = 0.006), and mastectomy (p < 0.001) independently predicted axillary surgery. Comedonecrosis and palpable lesions were associated with higher SNB rates but not nodal positivity.
CONCLUSIONS: Routine axillary surgery is unnecessary in VAB-diagnosed DCIS. Omission of SNB appears safe for patients undergoing BCS without high-risk features (palpability, high grade). Axillary staging may be reserved for mastectomy candidates or those with suspicions imaging of invasive disease.