乳腺导管原位癌腋窝淋巴结转移风险评估与手术决策制定OA

Objective To investigate independent risk factors for axillary lymph node metastasis(ALNM)and establish a stratified management strategy in patients who were diagnosed as breast ductal carcinoma in situ(DCIS)via core needle biopsy,so as to optimize clinical decision-making for sentinel lymph node biopsy(SLNB).Methods Clinical and pathological data of 352 patients with breast cancer(BC)who were diagnosed as DCIS via preoperative core needle biopsy and underwent SLNB in The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2021 were retrospectively analyzed.Univariate and multivariate Logistic regression analyses were performed to identify risk factors that were associated with lymph node metastasis.Results Postoperative pathological upgrading to invasive carcinoma occurred in 51.1%(180/352)of BC patients who were diagnosed as DCIS via core needle biopsy before operation,including 22.2%of microinvasive carcinoma and 28.9%of pT1 or higher-stage tumors.The overall ALNM rate was 6.5%(23/352),and all metastatic cases occurred in patients with postoperative pathological upgrading(no metastasis observed in simple DCIS).Multivariate Logistic regression analysis showed that grade 4c in Breast Imaging-Reporting and Data System(BI-RADS 4c)(OR=4.29,95%CI:1.13-16.30)and preoperative core needle biopsy pathological results suspecting invasive components(OR=3.32,95%CI:1.30-8.45)were independent risk factors(both P<0.05).In the ALNM group,the proportions of patients who presented with palpable masses(87.0%vs.53.5%,P=0.005)and imaging-based maximum tumor diameter≥20mm(60.9%vs.41.0%,P=0.063)were significantly higher compared with the non-ALNM group.Conclusion The patients with DCIS diagnosed via preoperative core needle biopsy face a potential risk of postoperative pathological upgrading to invasive breast cancer.BI-RADS 4c grade and preoperative core needle biopsy pathological results suspicion of invasive components are pivotal predictors of ALNM.After comprehensive evaluation,a stratified surgical strategy is recommended:routine SLNB should be performed for those patients who plan to undergo mastectomy or those with high-risk characteristics(such as BI-RADS 4c/5 grades,intermediate/high nuclear grade,comedonecrosis,palpable mass or tumor size>2cm).SLNB can be safely omitted in these low-risk patients with BI-RADS≤4b grade or low nuclear grade without suspicious invasive components).