Sentinel lymph node biopsy (SLNB) is recommended for patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, given the concerns regarding upstaging and technical difficulties of post-mastectomy SLNB. However, this may lead to potential overtreatment, considering favorable prognosis and de-escalation trends in DCIS. Data regarding upstaging and axillary lymph node metastasis among these patients remain limited. We retrospectively reviewed patients with DCIS who underwent mastectomy with SLNB or axillary lymph node dissection at Gangnam Severance Hospital between January 2010 and December 2021. To explore the feasibility of omitting SLNB, we assessed the rates of DCIS upgraded to invasive carcinoma and axillary lymph node metastasis. Binary Cox regression analysis was performed to identify clinicopathologic factors associated with upstaging and axillary lymph node metastasis. Among 385 patients, 164 (42.6%) experienced an invasive carcinoma upgrade: microinvasion, pT1, and pT2 were confirmed in 53 (13.8%), 97 (25.2%), and 14 (3.6%) patients, respectively. Seventeen (4.4%) patients had axillary lymph node metastasis. Multivariable analysis identified age ≤ 50 years (adjusted odds ratio [OR], 12.73; 95% confidence interval [CI], 1.18–137.51; p = 0.036) and suspicious axillary lymph nodes on radiologic evaluation (adjusted OR, 9.31; 95% CI, 2.06–41.99; p = 0.004) as independent factors associated with axillary lymph node metastasis. Among patients aged > 50 years and/or no suspicious axillary lymph nodes, only 1.7–2.3%) experienced axillary lymph node metastasis. Although underestimation of the invasive component was relatively high among patients with DCIS undergoing mastectomy, axillary lymph node metastasis was rare. Our findings suggest that omitting SLNB may be feasible for patients over 50 and/or without suspicious axillary lymph nodes on radiologic evaluation.

中文翻译：

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导管原位癌乳房切除术中选择性省略前哨淋巴结活检：确定合格候选人

考虑到乳房切除术后 SLNB 的升期和技术困难，建议对接受乳房切除术的导管原位癌 (DCIS) 患者进行前哨淋巴结活检 (SLNB)。然而，考虑到 DCIS 的良好预后和降级趋势，这可能会导致潜在的过度治疗。有关这些患者的分期和腋窝淋巴结转移的数据仍然有限。我们回顾性分析了 2010 年 1 月至 2021 年 12 月期间在江南 Severance 医院接受乳房切除术并进行 SLNB 或腋窝淋巴结清扫术的 DCIS 患者。为了探讨省略 SLNB 的可行性，我们评估了 DCIS 升级为浸润癌和腋窝淋巴结转移的比率。进行二元Cox回归分析以确定与分期上调和腋窝淋巴结转移相关的临床病理因素。在 385 名患者中，164 名 (42.6%) 经历了浸润癌升级：分别有 53 名 (13.8%)、97 名 (25.2%) 和 14 名 (3.6%) 患者确认为微浸润、pT1 和 pT2。 17 例（4.4%）患者有腋窝淋巴结转移。多变量分析确定年龄 ≤ 50 岁（调整后比值比 [OR]，12.73；95% 置信区间 [CI]，1.18–137.51；p = 0.036）和放射学评估中可疑的腋窝淋巴结（调整后 OR，9.31；95% CI） ，2.06–41.99；p = 0.004）作为与腋窝淋巴结转移相关的独立因素。在年龄> 50岁和/或没有可疑腋窝淋巴结的患者中，只有1.7-2.3%经历了腋窝淋巴结转移。尽管接受乳房切除术的 DCIS 患者对侵袭性成分的低估相对较高，但腋窝淋巴结转移很少见。我们的研究结果表明，对于 50 岁以上和/或放射学评估中没有可疑腋窝淋巴结的患者，省略前哨淋巴结活检可能是可行的。