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Published on: June 1, 2019
Sentinel Lymph Node Biopsy in Elderly Patients With Aggressive Breast Cancer Subtypes: Real-World Clinical Utility
Daniel Otero-Romero1, Rubén Carramiñana-Nuño1, Dolores Arribas-Del-Amo1,2
1Breast Unit, Department of Surgery, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
Background And Objectives:
Sentinel lymph node biopsy (SLNB) is the standard approach for axillary staging in early breast cancer (BC), but the utility in older patients remains controversial. Several studies have demonstrated that omission of SLNB may be appropriate in patients with hormone receptor-positive/HER2-negative tumors, but these analyses typically exclude those with triple-negative (TN) and human epidermal growth factor receptor 2 (HER2)-positive subtypes. The aim of this exploratory study is to generate preliminary data on current practice and the clinical utility of SLNB in women aged 70 years or older with these higher-risk subtypes.
Methods:
Retrospective observational study including women aged ≥ 70 years with TN or HER2-positive BC and clinically node-negative (cN0) axilla prior to upfront surgery (US) or after neoadjuvant chemotherapy (NAC), who underwent surgical treatment between 2014 and 2024 at a single institution. Patients were stratified according to SLNB performance. The clinical utility of SLNB was assessed by evaluating its impact on adjuvant chemotherapy indication, and the number needed to screen (NNS) was calculated. Five-year cause-specific mortality was described using Kaplan-Meier estimates.
Results:
A total of 87 patients were included. SLNB was performed in 77% of cases (88% in the NAC group and 72.6% in the US group). Patients receiving NAC were younger and had fewer comorbidities, underscoring that well‑selected elderly patients can receive guideline‑concordant care. In the US cohort, women in whom SLNB was omitted were older (mean age, 88 vs. 76 years). SLNB changed adjuvant chemotherapy recommendations in only 2 of 45 patients (4.4%), corresponding to an NNS of 23 (95% CI, 7-84). No increase in axillary recurrence or BC-specific mortality was observed after SLNB omission. Patients in whom SLNB was omitted had a markedly higher 5-year other-cause mortality than those who underwent SLNB (35.3% vs. 8.9%).
Conclusions:
The findings of this study suggest that, in selected older patients with limited life expectancy, the clinical utility of SLNB may be limited, highlighting the need for individualized decision-making regarding axillary staging. Larger studies are needed to better define the criteria for de-escalating axillary staging in this population.
