Is it Wise to Omit Sentinel Node Biopsy in Elderly Patients with Breast Cancer?

Background. The Society of Surgical Oncology's Choosing Wisely (R) guidelines recommend against routine sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0), hormone receptor (HR)-positive breast cancer patients aged >= 70 years. We examined the effect of SLNB on treatment and outcomes in this population. Materials and Methods. A single-institution retrospective review of consecutive cN0 women >= 70 years of age who received SLNB was performed. We collected clinicopathologic characteristics and treatment data. Patients were compared according to SLN status with subset analysis of HR-positive patients. Outcomes were analyzed using the Kaplan-Meier method and univariable analysis, and were compared using log-rank tests. Results. Of 500 patients, 345 (69%) were SLN-negative. Median age was 74 years (range 70-96). Most tumors were T1 (72%), N0 (69%), invasive ductal (77%), without lymphovascular invasion (88%), estrogen receptor-positive (88%) and progesterone receptor-positive (75%), and human epidermal growth factor receptor 2 (HER2)-negative (88%) treated with lumpectomy (71%). Median number of SLNs obtained was 2 (range 0-12) and median number of positive SLNs was 0 (range 0-8). Characteristics of the HR-positive subset were similar. In both the overall cohort and the HR-positive subset, SLN status significantly affected the use of adjuvant chemotherapy, although no significant effect on recurrence was observed. SLN-negative patients had better overall survival and less distant recurrence (bothp < 0.0001). Adjuvant hormone therapy significantly improved overall survival. Conclusions. SLNB can be safely omitted in elderly patients with T1, HR-positive, invasive ductal carcinoma tumors, but may still provide important information affecting treatment. Patients who are candidates for adjuvant systemic chemotherapy should still be considered for SLNB.

Automated summary

This study examined the impact of SLNB on treatment and outcomes in breast cancer patients aged >= 70 years who were clinically node-negative and hormone receptor-positive. The results indicated that SLN-negative patients had better overall survival and less distant recurrence, while adjuvant hormone therapy significantly improved overall survival.