Do Not Rush to Omit Sentinel Lymph Node Biopsy for Early Breast Cancer Patients

Recent data suggest that sentinel lymph node biopsy (SLNB) can be omitted in select patients with early breast cancer. The aim of this study was to determine the utility of SLNB for patients with early breast cancer.

A retrospective analysis of patients diagnosed with breast cancer in a Level IV hospital in Dublin, Ireland, between December 2013 and March 2024 was conducted. Inclusion criteria included: female patients ≥ 18 years, with cT1 disease and a negative preoperative axillary ultrasound, who underwent breast conserving surgery and a SLNB.

In total, 334 patients were included. The median age was 59 years (26-91 years). The majority had invasive ductal carcinoma (261 patients, 78.1%) and were hormone receptor-postive and human epidermal growth factor receptor 2-negative (274 patients, 82%). Final N stage was N0 in 282 (84%) of patients. Fifty-two patients (16%) had a positive-SLNB, despite a negative preoperative axilla. Twenty-four patients underwent an axillary clearance, of which 7 (14%) were positive, with only 3 patients (12.5%) upstaged following axillary clearance. Eighty-four patients (25%) received chemotherapy due to positive-SLNB. In line with contemporary data, 9 patients (2.7%) were eligible for CDK4/6 inhibitors, 48 patients (14%) for escalation to nodal radiation, or 275 patients (82%) for de-escalation to partial breast radiation.

While SLNB may be safely omitted in specific contexts, its omission carries the risk of under- and over-treatment. Our findings demonstrate that SLNB continues to guide adjuvant therapy for breast cancer patients, and thus, support the ongoing use of SLNB.