ROLE OF SENTINEL LYMPH NODE BIOPSY IN HIGH GRADE DUCTAL CARCINOMA IN SITU

Abstract

This prospective observational study explored the clinical relevance of sentinel lymph node biopsy (SLNB) in patients diagnosed with high-grade ductal carcinoma in situ (DCIS) at Tertiary care hospital Karachi over a six-month period. Sixty female patients undergoing mastectomy or breast-conserving surgery were enrolled, all of whom received SLNB as part of their surgical management. Final histopathological analysis revealed that 33.3% of these patients had invasive carcinoma, with 16.7% showing microinvasion and another 16.7% exhibiting more extensive invasion. Notably, SLNB detected lymph node metastases in 48.3% of the cohort. SLN positivity was significantly associated with the presence of invasive disease (70% in invasive cases vs. 37.5% in non-invasive, p = 0.001), and was also closely linked with high-risk histopathological features such as comedonecrosis, calcifications, and microinvasion. Among patients who exhibited two or more of these features, the incidence of invasive carcinoma exceeded 60%, suggesting their strong predictive value for occult invasion and potential nodal spread. These findings indicate that SLNB may provide critical staging information even in patients preoperatively diagnosed with non-invasive DCIS, particularly those undergoing mastectomy or displaying aggressive pathological features. While this study did not find a statistically significant relationship between SLNB status and recurrence during the follow-up period, the high incidence of nodal involvement supports a selective approach to SLNB in high-grade DCIS. Implementing such a strategy could help refine treatment plans, avoid under-staging, and potentially improve outcomes, while still minimizing unnecessary procedures in low-risk patients. Future studies with longer follow-up and larger sample sizes should further assess the prognostic implications of SLNB findings and explore the integration of molecular and imaging biomarkers to enhance patient selection criteria.

High-grade ductal carcinoma in situ (DCIS), Sentinel lymph node biopsy (SLNB), Occult invasion, Microinvasion, Comedonecrosis, Calcifications, Breast cancer staging.