Axillary management of breast ductal carcinoma in situ with microinvasion: experience from a single institution

Introduction The decision regarding the surgical management of the axilla in ductal carcinoma in situ (DCIS) with microinvasion (DCISM) remains a controversial issue for surgeons. We aimed to define the clinicopathological parameters linked to axillary lymph node (LN) metastasis and the role of axillary staging in these cases. Patients and methods All cases of DCISM diagnosed from 2008 to 2016 in Menoufia University Hospitals, Egypt, were identified. The clinicopathological, surgical management, and outcome data were retrieved. Results A total of 48 cases of DCISM were included. Axillary surgery was performed for 37 (77.1%) cases. Only two (5.4%) cases showed positive LN metastasis, and those cases were above the age of 50 years, with a tumor size of more than 2 cm, estrogen receptor negative, high grade, and associated with comedo necrosis. A significant correlation was identified between human epidermal growth factor receptor 2 positivity and the presence of LN metastasis (P=0.033). No significant association was detected between the surgical modality, axillary surgery, or presence of nodal metastasis and overall survival (P=0.494, P=0.097, and P=0.711, respectively). Conclusion DCISM has a similar outcome as pure DCIS with low rate of LN metastasis. Axillary staging for DCISM should not be done as a routine, and only high-risk patients could be offered axillary surgery after discussion in the MDT.