Sophie Henry

Recent Yale research has found that a common procedure used for treating invasive cancer does not improve outcomes for early-stage breast cancer patients.

The study is the first evidence that sentinel lymph node biopsies do not benefit patients with a breast cancer called ductal carcinoma in situ, or DCIS. About 60,000 people in the U.S. are diagnosed with DCIS annually, and the finding may help establish better treatment guidelines.

“We want to see whether interventions can affect outcomes,” said Shi-Yi Wang, a study co-author and a Yale School of Public Health epidemiology professor. “Our paper provides evidence that these sentinel lymph node biopsies provide no benefit for ductal carcinoma in situ. Previously, there was no research examining this issue. That is why our paper is important.”

DCIS is the earliest form of breast cancer diagnosed and forms within the milk duct. Doctors use sentinel lymph node biopsies to remove tumors and determine if the cancer has metastasized to the axillary lymph nodes in the underarm area.

Using a dataset of 12,000 patients, the study analyzed incidents of breast cancer occurring in the same breast after treatment with the biopsy. The results suggested that use of sentinel lymph node biopsies could not be significantly correlated to positive outcomes and the prognoses of those who underwent the procedure did not significantly differ from those who had not.

The finding is important, “as unnecessary surgery places patients at higher risk for surgical complications and adds to overall healthcare costs,” according to co-author and Yale associate surgery professor Brigid Killelea.

But most surgeons have stopped performing these biopsies for DCIS, according to Donald Lannin, a School of Medicine professor and former executive director of the Smilow Cancer Hospital.

“Because a small percentage chance of spread exists, some surgeons were still conducting these biopsies for treating DCIS patients,” said Lannin, who was not involved with the study. “This is the most conclusive article that shows that sentinel lymph node biopsy is not required for treating DCIS in patients undergoing lumpectomy.”

The findings could lead to new diagnostic tools for determining treatment options. In the future, Wang said he hopes to “examine other interventions and develop a tool, such as a decision aid, for facilitating decision-making processes” with additional funding.

This research, published in the Journal of the National Cancer Institute Cancer Spectrum, was funded by the Patient-Centered Outcomes Research Institute.

Maya Geradi | maya.geradi@yale.edu