Category Archives: Sentinel Lymph Node

Lobular Carcinoma In Situ, a incidental finding, consider Tamoxifen

Lobular Carcinoma In Situ

  • Usually incidental finding at biopsy
  • Younger premenopausal women
  • 1% risk of breast cancer per year
  • The future cancer can appear in either breast
  • If surgery is to be considered, the procedure of choice is bilateral mastectomy
  • Tamoxifen can reduce future risk of breast cancer by 50%

Increased probability of developing a carcinoma of the breast

  • This can happen in 20-30 years after diagnosis of LCIS (Lobular carcinoma in situ)
  • 1% risk increase of breast cancer per year in someone diagnosed with LCIS
  • No role for sentinel lymph node biopsy.
  • Treatment for Lobular Carcinoma In Situ (LCIS)
  • Close observation
  • Consider repeat mammogram in 6 months.
  • Informed of increased risk of breast cancer
  • No role for re-excision, SLN or irradiation.
  • Tamoxifen should be considered with a nearly 50% reduction in cancer formation in women with LCIS
  • For patients who insist on a surgical operation – a bilateral total mastectomy would be the procedure of choice because the risk of breast cancer is equal on both sides.
Tamoxifen mechanism of action.  Breast Cancer.
Tamoxifen mechanism

Sentinel Lymph Node Surgery for Breast Cancer

Sentinel Lymph Node Dissection

  • First applied to breast cancer patients in 1991
  • first widespread use was for cutaneous melanoma
  • SLN decreases axillary morbidity.  Lymphedema is 1%-3%.  Decreased risk of parethesias.
  • The axillary recurrence rate was 0% with the negative sentinel lymph node group in one of the studies.
  • Frozen section examinations of the lymph nodes in the OR has a false negative rate of 10-15%.

Axillary Lymph Node status in Breast Cancer

  • Axillary lymph node status is the strongest prognostic indicator for breast cancer patients.
  • Axillary lymph node status most likely doesn’t need identification with DCIS (Ductal Carcinoma In Situ) disease.  There is less than a 1% chance of a positive lymph node status in the axilla with DCIS.
  • If there is a suspicion of an invasive component of breast cancer than consider sentinel lymph node procedure for diagnosing Axillary lymph node status.