Annals of Surgical Oncology
INTRODUCTION: SSO published guidelines suggesting that surgeons should not routinely perform sentinel lymph node (SLN) biopsies for patients (pts) * 70 years of age (yo) with hormone receptor positive, her2 negative (HR+her2-) early stage invasive breast cancer (IBC). METHODS: We evaluated HR+her2- early stage IBC patients (pts) who were accrued to a multicenter trial between 2016-2018. Lymph node (LN) evaluation was left to the discretion of the treating surgeon. We sought to determine whether those * 70 yo were treated differently in terms of LN staging than their younger counterparts, the results of the SLN biopsy, and its impact on adjuvant chemotherapy (ctx). RESULTS: 229 pts with IBC < 2 cm participated in this study; 76 (33.2%) were * 70 yo. ER, PR and her2 status was known in 201 (87.8%). The proportion of pts who were HR+her2- was similar in the older vs. younger cohort (89.9% vs. 86.4%, respectively, p=0.653). Of those who were HR+her2-, the older cohort was no different from the younger in terrms of pt race, ethnicity, size and grade of the IBC, palpability, EIC and LVI. SLN biopsy was equally likely to be performed in the older and younger cohorts (91.9% vs. 97.4%, respectively, p=0.132), and final LN positivity was also similar for both groups (12.6% vs. 14.0%, respectively, p=0.812). Pts in the older group were less likely to receive ctx (5.9% vs. 19.4%, p=0.029), as were LN negative patients (9.9% vs. 47.6% for LN positive patients, p<0.001). On multivariate analysis, both of these factors were found to be independent predictors of receipt of ctx. While younger pts were five times as likely to receive ctx than their older counterparts (OR=5.295; 95% CI: 1.297-21.612, p=0.020) independent of LN status, those who were LN positive were ten times as likely to receive ctx than their LN negative counterparts (OR=10.772; 95% CI: 3.423-33.900, p<0.001) independent of age. Indeed, among pts * 70 yo, LN positive patients were more likely to receive ctx than those who were LN negative (25.0% vs. 2.6%, p=0.071). CONCLUSION: Despite the “Choosing Wisely” guideline, over 90% of pts * 70 yo with HR+her2- IBC underwent a SLN biopsy. SLN status influenced the receipt of adjuvant ctx in these pts.
Chagpar A, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger A, et al. Are Surgeons Still Doing Sentinel Node Biopsies In Older Women? 2021 Feb;28(SUPPL 1):S67. Available from: https://link.springer.com/content/pdf/10.1245/s10434-021-09682-9.pdf