There are many considerations that go into a surgical plan. I cannot list them all and I do not pretend to know all of them. A breast surgeon is better equipped to answer this question for you. He or she should know the details of this answer and what would be best under any given circumstances. I defer to their expertise. I cannot understate this.
However, this is my understanding of general treatment guidelines for stage 0 breast cancer which is also known as DCIS, or in other words, cancer that is still contained within the ducts of the breast.
First, I have to make some assumptions here because the information was not provided in your question, but let's assume that you or someone you know was recently diagnosed with DCIS from a core needle biopsy.
This most commonly, but not always, occurs in the setting of stereotactic guided core needle biopsy of suspicious calcifications in the breast seen on a mammogram. Less commonly (about 10 percent of the time) DCIS can actually present as a mass and is then sometimes diagnosed with an ultrasound guided core biopsy.
In any event, as long as a lumpectomy is going to be performed (the most common surgical procedure for DCIS discovered on needle biopsy), sentinel lymph node biopsy can be skipped if it is not very “likely” that there is any invasive cancer that was missed on the original biopsy. This is fairly subjective and may take into account local and regional differences as well as surgeon and patient considerations and preferences.
Up to approximately 10 percent of the time (depends on the research that you read) what was believed to be DCIS from a needle biopsy actually ends up showing that there was an invasive cancer when lumpectomy is performed. In this case the traditional guidelines still recommend sentinel node biopsy. In this cases, many of these patients would then need a second biopsy.
In order to avoid this, if there is a larger area of suspicious calcification than what was biopsied originally biopsied, then a sentinel biopsy may be wise to perform at the time of initial surgery. On the other end of the spectrum, if a large core needle was used for the original biopsy and the entire area of suspicion was removed, it's not likely that the DCIS will be upstaged to invasive breast cancer at the time of surgery and sentinel mode biopsy may not be necessary.
Obviously there are many many more considerations that come into play so the final recommendations from surgeons may still differ from what I have described. Additionally, a lot of newer research is being published that challenges the status quo about stage 0 breast cancer and which may come into play when designing a treatment plan. Finally, guidelines are constantly being refined so there is always a certain lag time as general practice patterns catch up and this also can contribute to different recommendations.
As stated earlier in this answer for you, I strongly recommend that you visit with your surgeon and or oncologist to discuss the treatment plan that is best for you. I hope this helps.
Ryan Polselli, MD, Diplomate of the American Board of Radiology, Fellowship Trained Breast Imaging Radiologist
The above information is intended as general information and is not intended to be medical advice.
For more information about topics related to breast cancer screening and diagnosis, visit Dr. Ryan Polselli's blog, Mammography Matters. You can also obtain more information at his facebook page, Dr. Ryan Polselli. Please visit and like!
However, this is my understanding of general treatment guidelines for stage 0 breast cancer which is also known as DCIS, or in other words, cancer that is still contained within the ducts of the breast.
First, I have to make some assumptions here because the information was not provided in your question, but let's assume that you or someone you know was recently diagnosed with DCIS from a core needle biopsy.
This most commonly, but not always, occurs in the setting of stereotactic guided core needle biopsy of suspicious calcifications in the breast seen on a mammogram. Less commonly (about 10 percent of the time) DCIS can actually present as a mass and is then sometimes diagnosed with an ultrasound guided core biopsy.
In any event, as long as a lumpectomy is going to be performed (the most common surgical procedure for DCIS discovered on needle biopsy), sentinel lymph node biopsy can be skipped if it is not very “likely” that there is any invasive cancer that was missed on the original biopsy. This is fairly subjective and may take into account local and regional differences as well as surgeon and patient considerations and preferences.
Up to approximately 10 percent of the time (depends on the research that you read) what was believed to be DCIS from a needle biopsy actually ends up showing that there was an invasive cancer when lumpectomy is performed. In this case the traditional guidelines still recommend sentinel node biopsy. In this cases, many of these patients would then need a second biopsy.
In order to avoid this, if there is a larger area of suspicious calcification than what was biopsied originally biopsied, then a sentinel biopsy may be wise to perform at the time of initial surgery. On the other end of the spectrum, if a large core needle was used for the original biopsy and the entire area of suspicion was removed, it's not likely that the DCIS will be upstaged to invasive breast cancer at the time of surgery and sentinel mode biopsy may not be necessary.
Obviously there are many many more considerations that come into play so the final recommendations from surgeons may still differ from what I have described. Additionally, a lot of newer research is being published that challenges the status quo about stage 0 breast cancer and which may come into play when designing a treatment plan. Finally, guidelines are constantly being refined so there is always a certain lag time as general practice patterns catch up and this also can contribute to different recommendations.
As stated earlier in this answer for you, I strongly recommend that you visit with your surgeon and or oncologist to discuss the treatment plan that is best for you. I hope this helps.
Ryan Polselli, MD, Diplomate of the American Board of Radiology, Fellowship Trained Breast Imaging Radiologist
The above information is intended as general information and is not intended to be medical advice.
For more information about topics related to breast cancer screening and diagnosis, visit Dr. Ryan Polselli's blog, Mammography Matters. You can also obtain more information at his facebook page, Dr. Ryan Polselli. Please visit and like!