Sentinel Lymph Node Dissection Is Technically Feasible in Older Breast Cancer Patients

Valero, Vicente; Kong, Amanda L.; Hunt, Kelly K.; Yi, Min; Hwang, Rosa F.; Meric‐Bernstam, Funda; Bedrosian, Isabelle; Ross, Merrick I.; Babiera, Gildy; Litton, Jennifer; Mittendorf, Elizabeth A.

doi:10.3816/cbc.2010.n.063

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Notwithstanding the fact that another retrospective study involving a total of only 141 patients pointed out that the probability of omitting SLNB increased with age in 70 years or older patients with ER-positive, HER2-negative, and clinical T1N0 invasive breast cancer (14), few studies have accurately pointed out a specific population that would be exempt from SLNB. In the present study, patients aged 70 years or more were defined as elderly, which is in keeping with the general literature, where 70 years has become an accepted definition (10)(11)(12)(13)22). Deaths due to breast cancer (23.8%, 941/3,952) are low in relation with elderly patients, which may be explained by low median follow-up time (39 months), as well as the fact that older people are more likely to die from multiple comorbidities such as cardiovascular disease, diabetes mellitus, and other chronic diseases compared with younger people.…”

Section: Discussionsupporting

confidence: 62%

“…For elderly patients who often face multiple comorbidities and have a lower tolerance of aggressive treatment than the younger patients, the risk of SLNB must be balanced with the benefit of staging and local control. While earlier studies suggested that SLNB should be offered in elderly patients ( 9 – 11 ), several recent studies indicated that elderly patients with early-stage and hormone-positive breast cancer gained limited survival benefit from SLNB resulting in an increasing omission of SLNB in appropriately selected patients ( 12 – 14 ). Several ongoing prospective trials, such as the Sentinel node vs.…”

Section: Introductionmentioning

confidence: 99%

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Predicting Survival Benefit of Sparing Sentinel Lymph Node Biopsy in Low-Risk Elderly Patients With Early Breast Cancer: A Population-Based Analysis

Wen

et al. 2020

Front. Oncol.

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The application of sentinel lymph node biopsy (SLNB) in elderly patients with early breast cancer remains somewhat controversial. This study aimed to establish individualized nomograms to predict survival outcomes of elderly patients with and without SLNB and find out which patients could avoid SLNB. Methods: A total of 39,962 ≥70-year-old patients diagnosed with T1-T2 breast cancer in 2010-2015 were included from the Surveillance, Epidemiology, and End Results (SEER) program and were divided into the training set (n = 29,971) and the validation set (n = 9,991). Axillary surgery was not specified in the SEER database, and we defined removing one to five lymph nodes as SLNB. Survival analysis was performed using the Kaplan-Meier plot and log-rank test. Multivariate Cox analysis was utilized to identify risk factors for overall survival (OS) and breast-cancer-specific survival (BCSS). Nomograms and a risk stratification model were constructed. Results: In the training set, patients with SLNB had better OS (adjusted HR 0.57, P < 0.001) and BCSS (adjusted HR 0.55, P < 0.001) than patients without SLNB. Multivariate COX analysis identified age, marital status, grade, subtype, T stage, and radiation as independent risk factors for OS and BCSS in both SLNB and non-SLNB groups (all P < 0.05). They were subsequently incorporated to establish nomograms to predict 3-and 5-year OS and BCSS for patients with or without SLNB. The concordance index ranged from 0.687 to 0.820, and calibration curves in the internal set and external set all demonstrated sufficient accuracies and good predictive capabilities. Further, we generated a risk stratification model which indicated that SLNB improved OS and BCSS in high-risk group (OS: HR 0.49, P < 0.001; BCSS: HR 0.54, P < 0.001), but not in the low-risk group (all P > 0.05). Conclusion: Well-validated nomograms and a risk stratification model were constructed to evaluate survival benefit from SLNB in elderly patients with early-stage breast cancer. Xu et al. SLNB in Elderly Breast Cancer SLNB was important for patients in the high-risk group but could be omitted in the low-risk group without sacrificing survival. This study could assist clinicians and elderly patients to weigh the risk-benefit of SLNB and make individualized decisions. We look forward to more powerful evidence from prospective trials.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Predicting Survival Benefit of Sparing Sentinel Lymph Node Biopsy in Low-Risk Elderly Patients With Early Breast Cancer: A Population-Based Analysis

Wen

et al. 2020

Front. Oncol.

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“…Sentinel lymph node biopsy (SLNB) is well established and accurate for local staging in patients with clinical negative lymph nodes. Before biopsy, lymphoscintigraphy can be successfully used to map sentinel lymph nodes providing detection rates of 85–98% [ 5 – 8 ]. Over the last years continuous changes in the technical performance of sentinel lymph node mapping (SLNM) have been introduced.…”

Section: Introductionmentioning

confidence: 99%

Impact of Tumor Localization and Method of Preoperative Biopsy on Sentinel Lymph Node Mapping After Periareolar Nuclide Injection

et al. 2016

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BackgroundTo evaluate whether tumor localization and method of preoperative biopsy affect sentinel lymph node (SLN) detection after periareolar nuclide injection in breast cancer patients.Methods and Findings767 breast cancer patients were retrospectively included. For lymphscintigraphy periareolar nuclide injection was performed and the SLN was located by gamma camera. Patient and tumor characteristics were correlated to the success rate of SLN mapping. SLN marking failed in 9/61 (14.7%) patients with prior vacuum-assisted biopsy and 80/706 (11.3%) patients with prior core needle biopsy. Individually evaluated, biopsy method (p = 0.4) and tumor localization (p = 0.9) did not significantly affect the SLN detection rate. Patients with a vacuum-assisted biopsy of a tumor in the upper outer quadrant had a higher odds ratio of failing in SLN mapping (OR 3.8, p = 0.09) compared to core needle biopsy in the same localization (OR 0.9, p = 0.5).ConclusionsTumor localization and preoperative biopsy method do not significantly impact SLN mapping with periareolar nuclide injection. However, the failure risk tends to rise if vacuum-assisted biopsy of a tumor in the upper outer quadrant is performed.

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Malignant Breast Tumors

2013

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Sentinel Lymph Node Dissection Is Technically Feasible in Older Breast Cancer Patients

Cited by 4 publications

References 26 publications

Predicting Survival Benefit of Sparing Sentinel Lymph Node Biopsy in Low-Risk Elderly Patients With Early Breast Cancer: A Population-Based Analysis

Predicting Survival Benefit of Sparing Sentinel Lymph Node Biopsy in Low-Risk Elderly Patients With Early Breast Cancer: A Population-Based Analysis

Impact of Tumor Localization and Method of Preoperative Biopsy on Sentinel Lymph Node Mapping After Periareolar Nuclide Injection

Malignant Breast Tumors

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