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ER, PR, and HER-2 status have been extensively studied in invasive breast cancer, while less data is available regarding ER, PR and HER-2 in MIBC 6, 16, 17. There are many considerations for surgical interventions: poor cosmesis after surgery, chronic pain due to sentinel lymph node biopsy procedure in the axilla, and the possibility of no long-term outcome difference following procedure 13. The Marmot Report published in 2012 acknowledge the negative effects of overtreatment to women’s health 15. Therapeutic approaches can result in overtreatment of some patients with breast cancer. In a large study of 2609 patients with MIBC who underwent SLNB, only 76 (2.9%) patients were found to have sentinel lymph node metastases 14. The role of sentinel lymph node biopsy (SLNB) in MIBC is currently not well defined, while the rate of axillary metastases has been observed to be very low (0–11%) 10, 13. For the purposes of treatment decision making, validating the reproducibility for different methods of risk stratification in MIBC will be important. 11 demonstrated 20-year breast cancer-specific mortality to be 3.8% for pure DCIS, and 6.9% for MIBC, with an adjusted hazard ratio for death associated with MIBC when compared to pure DCIS to be 2.00 (95% CI 1.76–2.26 p < 0.0001).Ĭompared to DCIS, MIBC is seen in association with high nuclear grades, necrosis, human epidermal growth factor receptor 2 (HER-2) positivity and a high Ki-67 positivity index, whereas the rates of estrogen receptor (ER) and progesterone receptor (PR) positivity are lower in patients with microinvasive carcinoma arising the background of extensive DCIS 12. Most recently, based on the records review of 525,395 women, Sopik et al. 10 showed a 10-year rate of recurrence free survival to be 90.7%. 9 showed the 5-year recurrence free survival to be 97.2%, although after 10 years of follow up Parikh et al. Like DCIS, MIBC has been reported to be associated with good overall clinical outcomes. MIBC arises in the setting of DCIS and generally, patients diagnosed with DCIS have a normal life expectancy and a long-term survival of around 98% after 10 years 7, 8. Prior to this there was discrepant reporting of MIBC, with different definitions of microinvasion 1– 6, resulting in significant controversy. Microinvasive breast cancer (MIBC) is defined as invasion of less than 1 mm into adjacent stroma 1. It is important to acknowledge that surgical complications have been reported, and traditional metrics used for risk assessment in invasive breast cancer may not hold true in the setting of microinvasion. Certainly, the use of SLNB in MIBC is quite the conundrum. When comparing patients who had undergone SLNB to those which had not there was no difference in DFS. This suggests the use of SLNB may provide diagnostic information to some patients, although these are the anomalies. One positive lymph node case was discovered following SLNB in our study. Performing mastectomy, high nuclear grade, and negativity for ER and HER-2 were found to be associated with the use of SLNB, although none of these variables were found to be associated with DFS. Three patients with MIBC had recurrence, and two deceased, leaving five patients in total with poor long-term outcomes and a DFS rate of 93.1%. Our study included 72 MIBC patients with a mean patient follow-up time of 55 months. In this study we evaluated clinical and histological features in both MIBC and background DCIS including ER, PR, and HER-2, number of foci of MIBC, the extent of the DCIS, nuclear grade, presence of comedo necrosis, as well as surgical procedures, adjuvant treatment and follow up to identify variables which predict disease free survival (DFS), as well as the factors which influence clinical decision making. MIBC has a favorable prognosis and while metastasis to the axilla is rare, it can impact treatment recommendations. Whether sentinel lymph node biopsy (SLNB) should be performed in patients with microinvasive breast cancer (MIBC) has been a matter of debate over the last decade.
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