{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:21:44Z","timestamp":1740126104301,"version":"3.37.3"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,6,5]],"date-time":"2021-06-05T00:00:00Z","timestamp":1622851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Staging of the axilla is not routine in ductal cancer in situ (DCIS) although invasive cancer is observed in 20\u201325 per cent of patients at final pathology. Upfront sentinel lymph node dissection (SLND) is advocated in clinical practice guidelines in certain situations. These include expected challenges in subsequent SLN detection and when the risk for invasion is high. Clinical practice guidelines are, however, inconsistent and lead to considerable practice variability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Clinical practice guidelines for upfront SLND in DCIS were identified and applied to patients included in the prospective SentiNot study. These patients were evaluated by six independent, blinded raters. Agreement statistics were performed to assess agreement and concordance. Receiver operating characteristic curves were constructed, to assess guideline accuracy in identifying patients with underlying invasion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eight guidelines with relevant recommendations were identified. Interobserver agreement varied greatly (kappa: 0.23\u20130.9) and the interpretation as to whether SLND should be performed ranged from 40\u201390 per cent and with varying concordance (32\u201388 per cent). The diagnostic accuracy was low with area under the curve ranging from 0.45 to 0.55. Fifty to 90 per cent of patients with pure DCIS would undergo unnecessary SLNB, whereas 10\u201350 per cent of patients with invasion were not identified as \u2018high risk\u2019. Agreement across guidelines was low (kappa\u2009=\u20090.24), meaning that different patients had a similar risk of being treated inaccurately.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Available guidelines are inaccurate in identifying patients with DCIS who would benefit from upfront SLNB. Guideline refinement with detailed preoperative work-up and novel techniques for SLND identification could address this challenge and avoid overtreatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znab149","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T19:23:27Z","timestamp":1617996207000},"page":"1120-1125","source":"Crossref","is-referenced-by-count":3,"title":["Axillary evaluation in ductal cancer <i>in situ<\/i> of the breast: challenging the diagnostic accuracy of clinical practice guidelines"],"prefix":"10.1093","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3622-3575","authenticated-orcid":false,"given":"Andreas","family":"Karakatsanis","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University , Uppsala, Sweden"},{"name":"Breast Unit, Department of Surgery, Uppsala University Hospital , Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petros","family":"Charalampoudis","sequence":"additional","affiliation":[{"name":"Oncoplastic Breast Unit, University College London Hospitals , London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lida","family":"Pistioli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Di Micco","sequence":"additional","affiliation":[{"name":"Breast Unit, San Raffaele University Hospital , Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8952-9987","authenticated-orcid":false,"given":"Theodoros","family":"Foukakis","sequence":"additional","affiliation":[{"name":"Department of Oncology-Pathology, Karolinska Institute Stockholm , Stockholm, Sweden"},{"name":"Breast Centre, Theme Cancer, Karolinska University Hospital , Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonios","family":"Valachis","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine & Health, \u00d6rebro University , \u00d6rebro, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the SentiNot Trialists Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"W\u00e4rnberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger Olofsson","family":"Bagge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Staffan","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guyla","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imad","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Sundqvist","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ava","family":"Kwong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"St\u00e5lberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,6,5]]},"reference":[{"key":"2023063011164123500_znab149-B1","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1002\/bjs.9404","article-title":"Incidence of and risk factors for sentinel lymph node metastasis in patients with a postoperative diagnosis of ductal carcinoma in situ","volume":"101","author":"Zetterlund","year":"2014","journal-title":"Br J Surg"},{"key":"2023063011164123500_znab149-B2","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ejso.2014.09.003","article-title":"Variations in the management of the axilla in screen-detected ductal carcinoma in situ: evidence from the UK NHS breast screening programme audit of screen detected DCIS","volume":"41","author":"Nicholson","year":"2015","journal-title":"Eur J Surg Oncol"},{"key":"2023063011164123500_znab149-B3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.amjsurg.2016.04.019","article-title":"Is sentinel lymph node biopsy indicated in patients with a diagnosis of ductal carcinoma in situ? 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