In patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, sentinel lymph node biopsy (SLNB) is routinely performed due to the possibility of upstaging. However, invasive upstaging occurs in a small subset of patients, and the majority of SLNB are unnecessary and potentially harmful. This study evaluated the feasibility of a novel surgical strategy that omits SLNB during initial mastectomy in patients with DCIS.

This prospective study enrolled patient with DCIS scheduled for mastectomy. Sentinel lymph nodes (SLNs) were intraoperatively localized by tagging sutures and surgical clips. Secondary SLNB was performed in patients with final diagnosis of invasive disease. The primary endpoint was the detection rate of localized SLNs during secondary surgery. (clinicaltrials.gov NCT05912569)

A total of 75 patients with 78 DCIS lesions were enrolled in the trial. Five cases underwent SNLB during initial surgery due to palpable lymph nodes. Invasive upstaging was seen in seventeen patients, and among them, 11 patients underwent secondary SLNB with the median interval of 26 days. SLNs were not detected in first two patients with nodes marked with absorbable sutures. In the subsequent nine cases using slow-absorbing sutures and medium clips, SLNs were identified and removed in all cases. Overall, axillary staging was avoided in 62 DCIS lesions (79.5%).

For patients with DCIS undergoing mastectomy, intraoperative marking and preservation of sentinel lymph node using a simple and affordable technique can be an effective surgical strategy to minimize unnecessary axillary node staging.