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How to Optimize Deimplementation of Sentinel Lymph Node Biopsy?
Ida Dragvoll1,2, Anna M Bofin1, Håvard Søiland3,4
1Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway.
The Breast Journal
|January 1, 2025
Summary
Many elderly breast cancer patients still undergo sentinel lymph node biopsy due to high rates of axillary metastases and poor adherence to antihormonal therapy, despite guidelines recommending omission.
Area of Science:
- Oncology
- Surgical Oncology
- Geriatric Oncology
Background:
- Guidelines suggest omitting sentinel lymph node biopsy (SLNB) for low-risk elderly breast cancer patients.
- Clinician reluctance persists despite evidence supporting SLNB omission.
- This study investigates reasons for continued SLNB use in this demographic.
Purpose of the Study:
- To quantify postoperative axillary metastases in elderly breast cancer patients.
- To examine adherence to adjuvant antihormonal therapy in this population.
- To understand factors influencing the continued performance of SLNB.
Main Methods:
- Single-center retrospective cohort study of 98 elderly (≥70 years) breast cancer patients.
- Patients had hormone receptor-positive, T1 tumors and received 5-year antihormonal therapy.
- Analysis of postoperative histology for axillary metastases and medication adherence.
Main Results:
- Axillary lymph node metastases confirmed postoperatively in 36.3% of patients.
- Antihormonal therapy nonadherence observed in 33.7% of patients.
- Primary nonadherence (never collecting prescriptions) was 11.2%.
Conclusions:
- Clinical axillary assessment alone is insufficient for preoperative staging.
- Adherence to antihormonal therapy in elderly patients is not guaranteed.
- These findings may explain clinician hesitancy to omit SLNB in low-risk elderly breast cancer patients.
