Axillary evaluation in ductal cancer in situ of the breast: challenging the diagnostic accuracy of clinical practice guidelines

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Karakatsanis, AndreasUppsala universitet,Endokrinkirurgi,Uppsala Univ Hosp, Dept Surg, Breast Unit, Uppsala, Sweden. (author)

Axillary evaluation in ductal cancer in situ of the breast: challenging the diagnostic accuracy of clinical practice guidelines

Article/chapterEnglish2021

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2021-06-05
Oxford University Press (OUP),2021

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LIBRIS-ID:oai:gup.ub.gu.se/309985
https://gup.ub.gu.se/publication/309985URI
https://doi.org/10.1093/bjs/znab149DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-92179URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:149170774URI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-457945URI

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Language:English

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SwePubSwePub

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Funding agency:Swedish Breast Cancer Association (Bröstcancerförbundet)Uppsala University
Background: Staging of the axilla is not routine in ductal cancer in situ (DCIS) although invasive cancer is observed in 20-25 per cent of patients at final pathology. Upfront sentinel lymph node dissection (SLND) is advocated in clinical practice guidelines in certain situations. These include expected challenges in subsequent SLN detection and when the risk for invasion is high. Clinical practice guidelines are, however, inconsistent and lead to considerable practice variability. Methods: Clinical practice guidelines for upfront SLND in DCIS were identified and applied to patients included in the prospective SentiNot study. These patients were evaluated by six independent, blinded raters. Agreement statistics were performed to assess agreement and concordance. Receiver operating characteristic curves were constructed, to assess guideline accuracy in identifying patients with underlying invasion. Results: Eight guidelines with relevant recommendations were identified. Interobserver agreement varied greatly (kappa: 0.23-0.9) and the interpretation as to whether SLND should be performed ranged from 40-90 per cent and with varying concordance (32-88 per cent). The diagnostic accuracy was low with area under the curve ranging from 0.45 to 0.55. Fifty to 90 per cent of patients with pure DCIS would undergo unnecessary SLNB, whereas 10-50 per cent of patients with invasion were not identified as 'high risk'. Agreement across guidelines was low (kappa=0.24), meaning that different patients had a similar risk of being treated inaccurately. Conclusion: Available guidelines are inaccurate in identifying patients with DCIS who would benefit from upfront SLNB. Guideline refinement with detailed preoperative work-up and novel techniques for SLND identification could address this challenge and avoid overtreatment.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cancer and Oncology hsv//eng
lymph-node biopsy
american society
sentinel node
carcinoma
risk
population
dissection
mastectomy
management
dcis
Surgery

Added entries (persons, corporate bodies, meetings, titles ...)

Charalampoudis, P.Oncoplastic Breast Unit, University College London Hospitals, London, UK,Univ Coll London Hosp, Oncoplast Breast Unit, London, England. (author)
Pistioli, LidaGothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,Univ Gothenburg, Inst Clin Sci, Dept Surg, Sahlgrenska Acad, Gothenburg, Sweden.(Swepub:gu)xpisli (author)
Di Micco, R.Breast Unit, San Raffaele University Hospital, Milan, Italy,San Raffaele Univ Hosp, Breast Unit, Milan, Italy. (author)
Foukakis, T.Department of Oncology-Pathology, Karolinska Institute Stockholm, Stockholm, Sweden; Breast Centre, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden,Karolinska Inst Stockholm, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Breast Ctr, Theme Canc, Stockholm, Sweden. (author)
Valachis, Antonis,1984-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Oncology,Örebro Univ, Fac Med & Hlth, Dept Oncol, Örebro, Sweden.(Swepub:oru)asvs (author)
Uppsala universitetEndokrinkirurgi (creator_code:org_t)

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In:British Journal of Surgery: Oxford University Press (OUP)108:9, s. 1120-11250007-13231365-2168

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