Sentinel lymph node biopsy unnecessary for DCIS

Performing sentinel lymph node biopsy in older women with ductal carcinoma in situ (DCIS) has no long-term benefit, according to a study to be published in the December issue of JNCI Cancer Spectrum.

Sentinel lymph node biopsy is typically performed to see if cancer has begun spreading from the original tumor, and between 17% and 40% of women with DCIS undergo such biopsies, according to lead study author Dr. Shi-Yi Wang, PhD, of the Yale School of Public Health. But since DCIS is not invasive, biopsies for these patients aren't recommended.

Wang and colleagues conducted a study that compared health outcomes of 5,957 women who had undergone a lumpectomy to remove DCIS -- including 1,992 who had undergone a sentinel lymph node biopsy -- with 3,965 women who did not have a biopsy (JNCI Cancer Spectr, December 2019, Vol. 3:4, pkz052).

The team found that sentinel lymph node biopsies did not reduce the likelihood of dying from breast cancer, decrease the chances of developing invasive breast cancer, or decrease the number of additional cancer treatments. But the procedure did increase patient risk of biopsy-associated complications, including pain, wound infection, and lymphedema.

"Proponents of sentinel lymph node biopsy cite concerns that occult microinvasive disease within the DCIS may not be detected via other methods," Wang said in a statement released by Yale. The sentinel lymph node biopsy is also included in the U.S. Centers for Medicare and Medicaid Services' merit-based incentive payment system for invasive breast cancer, which "might create a financial incentive for providers to perform these biopsies even for noninvasive conditions," he noted.