Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The role of axillary surgery in ductal carcinoma in situ (DCIS) remains controversial, particularly for cases diagnosed via vacuum-assisted biopsy (VAB), which may reduce "upstage" to invasive disease. This study evaluates the incidence of axillary metastasis and pathologic upstaging in DCIS to identify subgroups where axillary staging can be safely omitted. 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.
Authors: Marcellus do Nascimento Moreira Ramos, André Mattar, Marcelo Antonini, Felipe Zerwes, Felipe Cavagna, Francisco Pimentel Cavalcante, Eduardo Camargo Millen, Fabricio Palermo Brenelli, Antonio Luiz Frasson, Marcelo Madeira, Andressa Gonçalves Amorim, Marina Diógenes Teixeira, Marina Fleury de Figueiredo, Larissa Chrispim de Oliveira, Leonardo Ribeiro Sorares, Gil Facina, Rogerio Fenile, Ruffo de Freitas Júnior, Renata Arakelian, Marcela Bonalumi dos Santos, Henrique Lima Couto, Renata Montarroyos Leite, Pedro Paulo de Andrade Gomes, Gabriela de Oliveira Gomes, Luiz Henrique Gebrim, Reginaldo Guedes Coelho Lopes, Juliana Monte Real
Institutions: Hospital do Servidor Público Estadual, Centro de Referência da Saúde da Mulher - Hospital da Mulher São Paulo, Hospital de Clínicas de Porto Alegre, Pontifícia Universidade Católica do Rio Grande do Sul, Hospital Geral de Fortaleza, Universidade Estadual de Campinas (UNICAMP), Hospital Israelita Albert Einstein, Universidade Federal de Goiás, Universidade Federal de São Paulo, Universidade Federal de Sergipe, Beneficência Portuguesa de São Paulo
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,990
OpenAlex ID: W4412364481