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Omitting SLNB in Breast Cancer: Is a Nomogram the Answer?

A M Moorman1, E J Th Rutgers2, E A Kouwenhoven3

  • 1Department of Surgery, Hospital Group Twente, Almelo, The Netherlands. yvettemoorman@gmail.com.

Annals of Surgical Oncology
|November 5, 2021
PubMed
Summary
This summary is machine-generated.

Sentinel lymph node biopsy (SLNB) may be safely omitted in about one-third of early breast cancer patients. A new predictive model identifies those with a low risk of nodal involvement, potentially reducing unnecessary surgeries.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Staging

Background:

  • Sentinel lymph node biopsy (SLNB) is standard for invasive breast cancer staging.
  • Low axillary recurrence rates after SLNB raise questions about its clinical necessity in early-stage disease.

Purpose of the Study:

  • To identify early breast cancer patients with a low risk of axillary disease burden.
  • To determine if SLNB can be omitted in selected patient groups.

Main Methods:

  • Retrospective analysis of 2015 primary breast cancer patients (2007-2015).
  • Development of a predictive nomogram using variables associated with nodal disease.
  • Validation of the nomogram in separate training and validation cohorts.

Main Results:

  • A predictive model incorporating age, cN0, morphology, grade, multifocality, and tumor size achieved an AUC of 0.83.
  • The model identified 32.8% of patients who could potentially avoid axillary surgery with a <5% false-negative rate.
  • A subgroup analysis showed 26.8% of patients had <5% risk of macrometastases.

Conclusions:

  • A validated nomogram can identify approximately one-third of patients who may not require SLNB due to low nodal involvement risk.
  • The clinical utility of omitting SLNB requires balancing the risk of missing nodal disease against procedural side effects.
  • Prospective trials are needed to confirm outcomes, but the nomogram can aid individual decision-making.