Tags

Type your tag names separated by a space and hit enter

Is it Wise to Omit Sentinel Node Biopsy in Elderly Patients with Breast Cancer?
Ann Surg Oncol. 2020 Jul 01 [Online ahead of print]AS

Abstract

BACKGROUND

The Society of Surgical Oncology's Choosing Wisely® 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 (both p < 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.

Authors+Show Affiliations

Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Mercy Clinic Breast Surgery - Coletta, Oklahoma City, OK, USA.Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Fred Hutchinson Cancer Research Center, Seattle, WA, USA.Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Marie.Lee@moffitt.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32613363

Citation

Sun, James, et al. "Is It Wise to Omit Sentinel Node Biopsy in Elderly Patients With Breast Cancer?" Annals of Surgical Oncology, 2020.
Sun J, Mathias BJ, Sun W, et al. Is it Wise to Omit Sentinel Node Biopsy in Elderly Patients with Breast Cancer? Ann Surg Oncol. 2020.
Sun, J., Mathias, B. J., Sun, W., Fulp, W. J., Zhou, J. M., Laronga, C., Loftus, L. S., & Lee, M. C. (2020). Is it Wise to Omit Sentinel Node Biopsy in Elderly Patients with Breast Cancer? Annals of Surgical Oncology. https://doi.org/10.1245/s10434-020-08759-1
Sun J, et al. Is It Wise to Omit Sentinel Node Biopsy in Elderly Patients With Breast Cancer. Ann Surg Oncol. 2020 Jul 1; PubMed PMID: 32613363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is it Wise to Omit Sentinel Node Biopsy in Elderly Patients with Breast Cancer? AU - Sun,James, AU - Mathias,Brittany J, AU - Sun,Weihong, AU - Fulp,William J, AU - Zhou,Jun-Min, AU - Laronga,Christine, AU - Loftus,Loretta S, AU - Lee,M Catherine, Y1 - 2020/07/01/ PY - 2020/03/10/received PY - 2020/7/3/entrez JF - Annals of surgical oncology JO - Ann. Surg. Oncol. N2 - BACKGROUND: The Society of Surgical Oncology's Choosing Wisely® 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 (both p < 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. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/32613363/Is_it_Wise_to_Omit_Sentinel_Node_Biopsy_in_Elderly_Patients_with_Breast_Cancer L2 - https://dx.doi.org/10.1245/s10434-020-08759-1 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.