Can axillary node dissection be safely omitted in the elderly? A retrospective study on axillary management of early breast cancer in older women

Esposito, E.; Sollazzo, Viviana; Micco, Rosa Di; Cervotti, Maria; Luglio, Gaetano; Benassai, Giacomo; Mozzillo, Pasquale; Perrotta, S.; Desiato, Vincenzo; Amato, Bruno; Forestieri, Pietro; Limite, Gennaro

doi:10.1016/j.ijsu.2016.06.022

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…These suggestions are in line with efforts to de‐escalate both surgery and adjuvant treatment for indolent breast disease. Examples of this include the reassessment of routinely sampling SLNB in patients with microinvasive carcinoma and in women over 70 years of age with early‐stage, ER‐positive, HER2‐negative invasive breast tumors 16‐21,29,30 . Patients with EPCs broadly fit into the latter group as shown in the present study as well as prior studies.…”

Section: Discussionsupporting

confidence: 65%

“…Data from the Z0011 trial, for example, challenged the historical standard approach for axillary staging 16 . More recent studies question whether SLNB can be safely omitted in elderly (age 70 and above) patients with early‐stage breast cancer that are clinically node‐negative 17‐20 . As part of the Choosing Wisely Campaign in 2016, the Society of Surgical Oncology recommended that surgeons “don't routinely use sentinel node biopsy in clinically node‐negative women >70 years of age with hormone receptor‐positive invasive breast cancer.” 21 Extrapolating from these aforementioned studies, the utility of SLNB in patients with EPCs should be called into question.…”

Section: Introductionmentioning

confidence: 99%

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Encapsulated papillary carcinoma with and without frank invasion: Comparison of clinicopathologic features and role of axillary staging

et al. 2021

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To investigate clinical and pathologic features of encapsulated papillary carcinomas (EPCs) that may be associated with invasive disease and characterize the axillary staging practices for EPCs at our institution. A pathology database search for cases containing “papillary carcinoma” was performed. Slides were reviewed by two pathologists. Clinicopathological features and axillary staging practices of EPCs with and without invasion were compared. Twenty‐five cases of EPCs were identified. Fifteen cases contained a frank invasive tumor (60%), which were all pT1 (0.7 ± 0.56 cm), and the majority were ER‐positive, HER2‐negative, low‐grade IDC‐NST. Seventeen patients underwent sentinel lymph node biopsies (SLNB). No nodal metastases were identified. Follow‐up was available for 24 patients (mean = 39 ± 29 months); 23 had no NED. Patients that presented with a self‐palpated mass (versus screening) were more likely to have an invasive component; however, no pathologic or radiologic features differentiated EPCs with and without frank invasion. Pathologic and radiologic characteristics did not differentiate EPCs with and without frank invasion. EPCs have an excellent prognosis supported by the notable disease‐free survival and negative nodal status in our cohort, which supports the notion that patients with EPCs may forgo axillary staging.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Encapsulated papillary carcinoma with and without frank invasion: Comparison of clinicopathologic features and role of axillary staging

et al. 2021

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“…As previously described, breakthrough trials have reduced indications for surgical resection through CALND in EBC, [6][7][8] and modern studies suggest exemption in elderly patients, given the associated morbidity, minimal survival benefit and oncological control following complete clearance of the axilla. 44,47 This recent vogue is further supported by randomized data illustrating no added survival advantage from performing CALND in patients aged > 70 years with clinically occult axillary lymph nodes. 48 Eighty percent of patients in this study had node negative disease, however, for those with node positive disease, proceeding to CALND failed to enhance locoregional control or survival.…”

Section: Discussionmentioning

confidence: 97%

Evaluating the Clinical Utility of Routine Sentinel Lymph Node Biopsy and the Value of Adjuvant Chemotherapy in Elderly Patients Diagnosed With Oestrogen Receptor Positive, Clinically Node Negative Breast Cancer

Davey

Ryan

Burke

et al. 2021

Breast Cancer�(Auckl)

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Background: Sentinel lymph node biopsy (SLNB) provides staging information and guides adjuvant therapy in early breast cancer (EBC). Routine SLNB in oncogeriatricians with low-risk EBC remains controversial. Aims: To evaluate axillary management in elderly patients diagnosed with oestrogen receptor positive (ER+), clinically lymph node negative (cLN−) EBC, and to assess whether SLNB affects further axillary management or adjuvant chemotherapy (ACTX) decision making. Methods: Female patients aged > 65 years, diagnosed with ER+, human epidermal growth factor receptor-2 negative (HER2−), and cLN− breast cancer (BC), who underwent surgery and SLNB were included. Clinicopathological predictors of ACTX and completion axillary lymph node dissection (CALND) were determined. Kaplan-Meier analyses assessed survival outcomes. Results: A total of 253 patients were included (median age: 72 years, range: 66-90), all underwent SLNB; 50 (19.8%) had lymphatic metastasis on SLNB (SLNB+). Of these, 19 proceeded to CALND (38.0%), 10 (52.6%) of whom had further axillary disease (ALND+). 20 of the 50 SLNB+ patients received ACTX (40.0%) as did 31 of the 203 SLNB− patients (15.2%) ( P < .001). Oncotype DX (ODX) testing was utilized in 82 cases (32.8%). Younger age ( P < .001), SLNB+ ( P < .001) and ODX score ( P = .003) were all associated with ACTX prescription. ODX > 25 (OR: 4.37, 95% CI: 1.38-13.80, P = .012) independently predicted receiving ACTX. Receiving ACTX and proceeding to CALND did not improve disease-free ( P = .485 and P = .345) or overall survival ( P = .981 and P = .646). Conclusions: Routine SNLB may not be necessary in elderly patients diagnosed with ER+, cLN− EBC. Future oncogeriatric practice is likely to see genomic testing guiding ACTX prescription in this group.

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“…The American Society of Clinical Oncology (ASCO) practice guidelines now allow to omit ALND to patients with micrometastatic and even 1-2 macrometastatic positive SLNs. (14) The Venezuelan Mastology Society published its Consensus of Sentinel Lymph Node in Mammary Carcinoma in 2010. This recommends performing ALND in all cases of macrometastasis and leaves the decision in the hands of each working group in cases of micrometastasis.…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Clinically Node Positive Axilla of Breast Cancer

Atrash

Shinawi

Osman

et al. 2020

Ain Shams Medical Journal

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Background: In the modern treatment of breast cancer, the Sentinel Lymph node biopsy indication is present in many clinical circumstances, instead of classical axillary lymphadenectomy. It presents the advantage of conservative surgery, which significantly decreases the rate of postoperative complications, offering the patients a better quality of Life and reducing the costs of patients care after surgery. Sentinel Lymph node biopsy (SLNB) vs. axillary Lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer. Aim of the Work: The aim of the present study is to evaluate staging the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in previous clinically node positive axilla in breast cancer to avoid the morbidity of an ALND. Patients and Methods: This was a prospective cohort study was held in El Demerdash hospital Ain Shams University hospitals, Cairo, Egypt started with one hundred and twenty female patients with clinically node positive axilla in breast cancer. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria. Results: Our study showed that SLNB is acceptable in cN1/2 patients who become cN0 after neoadjuvant therapy: particularly in those with no residual disease in the breast, because SN status maintains its expected prognostic role, but also in cases with residual disease, because Axillary dissection (AD) has no influence on outcomes. Conclusion: Sentinel lymph node biopsy will replace axillary lymph node dissection (ALND) in those patients with clinically node positive axilla without compromising their oncologic outcomes. Especially, rates of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have increased. In the neoadjuvant setting, SLN after NAC is feasible and accurate in clinically node positive patients as a continuous effort to avoid the morbidity of ALND.

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Can axillary node dissection be safely omitted in the elderly? A retrospective study on axillary management of early breast cancer in older women

Abstract: Based on current evidence, we spare well-informed and consenting patients from further axillary surgery when the SLN is minimally involved in early breast cancer within an agreed protocol, whilst scheduling adjuvant treatment based on the patients' primary tumour characteristics.

Cited by 9 publications

References 30 publications

Encapsulated papillary carcinoma with and without frank invasion: Comparison of clinicopathologic features and role of axillary staging

Encapsulated papillary carcinoma with and without frank invasion: Comparison of clinicopathologic features and role of axillary staging

Evaluating the Clinical Utility of Routine Sentinel Lymph Node Biopsy and the Value of Adjuvant Chemotherapy in Elderly Patients Diagnosed With Oestrogen Receptor Positive, Clinically Node Negative Breast Cancer

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Clinically Node Positive Axilla of Breast Cancer

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