Operative Axillary Diagnosis of DCIS - Special Evaluation of Data Collected by the Federal Quality Assurance Agency in 2008

AIM: The study examines the treatment situation associated with operative axillary diagnosis in cases with preoperative histological confirmation of DCIS. It investigates the lymph node metastasis rate in -cases of histologically confirmed pure DCIS under current diagnostic and operative conditions. MATERIALS AND METHODS: The study uses data col-lected by the Federal Quality Assurance Agency in 2008. RESULTS: DCIS confirmed by preoperative needle biopsy proved to be an invasive carcinoma in 20.40 to 25.57 % of all cases at the definitive histological workup and thus required SLNB. SLNB (or ALND) yielded positive findings in at least 17.51 % of these cases. Non-indicated ALND was performed in 4.27 to 2.21 % of the DCIS cases. An axillary intervention (SLNB or ALND) was dis-pensed with in only 64.40 % of the biopsy-con-firmed DCIS cases that were found to be non-invasive, which does not correspond to the current German guidelines. As ex-pect-ed, a trend -towards underestimation of large or high-grade DCIS cases was seen here. The 2008 qual-ity assur-ance data for breast cancer are marred by a certain number of input errors and software defects. Thus the data pool was not assessable in its en-tire-ty. Moreover, 33.10 % of the cases were not confirmed preoperatively and thus had to be ex-cluded. CONCLUSIONS: Since too many axillary interven-tions are apparently being performed, it is necessary to discuss whether the regularly updated German guide-lines should define the indication for SLNB more precisely in cases with a preoperative histo-log-ical diagnosis of DCIS.