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Is Axillary Staging Obsolete in Early Breast Cancer?

Monica Morrow1

  • 1Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.

Surgical Oncology Clinics of North America
|September 15, 2023
PubMed
Summary
This summary is machine-generated.

Sentinel lymph node biopsy can be omitted in early-stage, hormone-positive, HER2-negative breast cancer patients aged 70 or older. Nodal status remains crucial for radiotherapy decisions in younger postmenopausal women.

Keywords:
AxillaAxillary stagingEarly breast cancerLocal controlSentinel lymph node biopsy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Axillary staging is crucial for early-stage breast cancer management, impacting local control and adjuvant therapy decisions.
  • The incidence of nodal metastases varies significantly across different patient subgroups.
  • Clinical trials have investigated the necessity of axillary staging in specific breast cancer populations.

Purpose of the Study:

  • To review the incidence of nodal metastases in early-stage breast cancer.
  • To evaluate the role of axillary staging in local control and adjuvant systemic therapy decisions.
  • To analyze clinical trial data regarding axillary staging in breast cancer.

Main Methods:

  • Review of existing literature and clinical trial data on axillary staging in breast cancer.
  • Analysis of patient demographics, tumor characteristics (cT1-2 N0, HR+/HER2-), and age (≥70 years) in relation to nodal metastasis.
  • Evaluation of the impact of nodal status on radiotherapy and systemic therapy recommendations.

Main Results:

  • Sentinel lymph node biopsy can be safely omitted in women aged 70 years or older with clinical T1-2 N0, hormone receptor-positive (HR+)/HER2-negative breast cancers.
  • Nodal status remains a critical factor for selecting patients for radiotherapy in younger postmenopausal women with similar tumor characteristics.
  • Axillary staging is essential for comprehensive treatment planning in specific early-stage breast cancer cohorts.

Conclusions:

  • Omission of sentinel lymph node biopsy is appropriate for select elderly patients with early-stage, HR+/HER2- breast cancer.
  • Axillary staging continues to be vital for guiding adjuvant treatment, particularly radiotherapy, in younger postmenopausal women.
  • Personalized approaches to axillary staging are necessary based on patient age and tumor biology in early-stage breast cancer.