Most patients with ductal carcinoma in situ (DCIS) who undergo mastectomy currently receive a sentinel lymph node biopsy at the time of their operation, even though only a small minority will turn out to have invasive disease. A prospective trial now reports that a simple marking technique can allow surgeons to defer that biopsy until invasive cancer is actually confirmed, sparing the majority of patients an unnecessary axillary procedure.
The study, published in Breast Cancer Research, enrolled 75 patients with 78 DCIS lesions who were scheduled for mastectomy. Because DCIS can occasionally be upstaged to invasive cancer once the final pathology is available, sentinel lymph node biopsy is routinely performed during the initial operation. However, the researchers note that invasive upstaging occurs in only a small subset of patients, meaning most sentinel node biopsies in this setting are unnecessary and potentially harmful.
Instead of removing the nodes immediately, the surgical team localized the sentinel lymph nodes intraoperatively by placing tagging sutures and surgical clips. If the final diagnosis revealed invasive disease, a secondary sentinel lymph node biopsy was performed later. The primary endpoint of the trial was the detection rate of the localized nodes during this secondary surgery. The trial was registered at clinicaltrials.gov as NCT05912569.
Five patients in the study underwent sentinel node biopsy during the initial surgery because of palpable lymph nodes. Invasive upstaging was ultimately identified in seventeen patients, and eleven of these underwent the delayed secondary biopsy after a median interval of 26 days.
The technique required some adjustment. In the first two patients, whose nodes had been marked with absorbable sutures, the sentinel lymph nodes could not be detected at the time of secondary surgery. After that, the team switched to slow-absorbing sutures and medium clips, and in the subsequent nine cases the marked nodes were successfully identified and removed in every instance.
Overall, axillary staging was avoided in 62 of the 78 DCIS lesions, or 79.5 percent. The authors conclude that for patients with DCIS undergoing mastectomy, intraoperative marking and preservation of the sentinel lymph node using a simple and affordable technique can be an effective surgical strategy to minimize unnecessary axillary node staging.
The findings come with important caveats. The trial was small, and the two early failures with absorbable sutures show that the choice of marking material matters. The reported detection rate applies to the technique as refined during the study, and the results describe feasibility rather than long-term outcomes. Because the article is being shared early as a peer-reviewed, accepted manuscript, it remains subject to further editorial edits before the final version of record is published.
Even so, the study addresses a real clinical dilemma. Sentinel lymph node biopsy carries potential harms, and for most DCIS patients treated with mastectomy the procedure ultimately provides no staging information because no invasive disease is found. A strategy that defers the biopsy until it is actually needed could reduce those harms, provided the marked nodes can be reliably found later, as they were in all nine cases using the revised marking approach.
Subject of Research: Feasibility of delaying sentinel lymph node biopsy in DCIS patients undergoing mastectomy
Article Title: Feasibility of delaying sentinel node biopsy in ductal carcinoma in situ patients undergoing mastectomy: a prospective trial
Article References: Kang, E., Lee, C., Lee, M. J., Kang, H., Byeon, J., Jung, J.-J., Kim, H.-K., Lee, H.-B., Han, W., & Moon, H.-G. (2026). Feasibility of delaying sentinel node biopsy in ductal carcinoma in situ patients undergoing mastectomy: a prospective trial. Breast Cancer Research. https://doi.org/10.1186/s13058-026-02395-5
Image Credits: AI Generated
DOI: 10.1186/s13058-026-02395-5
Keywords: ductal carcinoma in situ, sentinel lymph node biopsy, mastectomy, breast cancer, axillary staging, prospective trial, invasive upstaging, surgical technique, lymph nodes, clinical trial, Feasibility, delaying
News Source: Nathaniel Bowman. (October 29, 2026). Delaying Sentinel Node Biopsy After Mastectomy Feasible for DCIS, Trial Shows. Scienmag.
