For patients with DCIS on biopsy but invasive disease in lumpectomy, are there any circumstances in which you would not recommend returning for a SNB?
For example, if the lumpectomy specimen had low risk/low volume invasive disease?
Answer from: Radiation Oncologist at Academic Institution
As in all invasive breast cancer, SLNBx is standard unless it will not affect management - and this is usually for the determination of systemic therapy, i.e., chemotx. Such as a patient whose comorbidities preclude chemo for pSLN+, or patients who meet the criteria for good outcomes without knowing...
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Answer from: Radiation Oncologist at Academic Institution
With omitting SLN, one can consider the risk of involved SLNs and discuss omitting SLN for low-risk patients. Also, patients meeting CALGB 9343 criteria may be able to skip SLN as the trial allowed for this.In patients under 65, I commonly see them getting SLN in these situations.
Answer from: Radiation Oncologist at Community Practice
Unless systemic treatment decision will change, would skip SLND. With more decisions about systemic treatment being made on genomic test and phenotype of cancer, the value of SNLN will change as data emerges. INSEMA is one such trial which presented QOL data at SABCS 2021 showing inferior QOL with S...