Can We Successfully De-Escalate Axillary Surgery in Women Aged ≥ 70 Years with Ductal Carcinoma in Situ or Early-Stage Breast Cancer Undergoing Mastectomy?

Matar, Regina; Barrio, Andrea V.; Sevilimedu, Varadan; Le, Tiana; Heerdt, Alexandra S.; Morrow, Monica; Tadros, Audree B

doi:10.1245/s10434-021-11140-5

Cited by 5 publications

(2 citation statements)

References 30 publications

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“…Pending results have the potential to change practice toward complete de-escalation of axillary surgery in many patients with negative ultrasound. Even though some of these trials are restricted to candidates for BCS, most of them include cancers up to 5 cm, all age groups, and all intrinsic subtypes, and the benefit of SLNB in patients undergoing mastectomy is increasingly questioned [ 49 ]. As results of these potentially practice changing trials are eagerly expected, it will be important to assess their impact on surgical clinical practice, adjuvant treatments and oncologic outcomes also by intrinsic subtypes in subsequent implementation studies.…”

Section: Discussionmentioning

confidence: 99%

Use of sentinel lymph node biopsy in elderly patients with breast cancer – 10-year experience from a Swiss university hospital

Heidinger¹,

Maggi²,

Dutilh³

et al. 2023

World J Surg Onc

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Background The Choosing Wisely initiative recommended the omission of routine sentinel lymph node biopsy (SLNB) in patients ≥ 70 years of age, with clinically node-negative, early stage, hormone receptor (HR) positive and human epidermal growth factor receptor 2 (Her2) negative breast cancer in August 2016. Here, we assess the adherence to this recommendation in a Swiss university hospital. Methods We conducted a retrospective single center cohort study from a prospectively maintained database. Patients ≥ 18 years of age with node-negative breast cancer were treated between 05/2011 and 03/2022. The primary outcome was the percentage of patients in the Choosing Wisely target group who underwent SLNB before and after the initiative went live. Statistical significance was tested using chi-squared test for categorical and Wilcoxon rank-sum tests for continuous variables. Results In total, 586 patients met the inclusion criteria with a median follow-up of 2.7 years. Of these, 163 were ≥ 70 years of age and 79 were eligible for treatment according to the Choosing Wisely recommendations. There was a trend toward a higher rate of SLNB (92.7% vs. 75.0%, p = 0.07) after the Choosing Wisely recommendations were published. In patients ≥ 70 years with invasive disease, fewer received adjuvant radiotherapy after omission of SLNB (6.2% vs. 64.0%, p < 0.001), without differences concerning adjuvant systemic therapy. Both short-term and long-term complication rates after SLNB were low, without differences between elderly patients and those < 70 years. Conclusions Choosing Wisely recommendations did not result in a decreased use of SLNB in the elderly at a Swiss university hospital.

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Section: Discussionmentioning

confidence: 99%

Use of sentinel lymph node biopsy in elderly patients with breast cancer – 10-year experience from a Swiss university hospital

Heidinger¹,

Maggi²,

Dutilh³

et al. 2023

World J Surg Onc

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“…Intradermal injection of isotope appears to produce the greatest uptake of radioactivity in the nodes. Blue dye has the complication of anaphylaxis manifested by oedema, erythema, tachycardia, "blue" The use of SLNB in the over-70 population has been debated, and there is acceptance that SLNB may not be necessary if the patient has clinically and ultrasound-negative axilla and HR+ early BC [18,19]. Patients of this age often have comorbidities and are at higher risk of adverse events following SLNB, and findings from a SLNB are unlikely to change the recommended adjuvant therapy [20].…”

Section: Diagnosismentioning

confidence: 99%

The Role of Nodes and Nodal Assessment in Diagnosis, Treatment and Prediction in ER+, Node-Positive Breast Cancer

Kay,

Martinez-Perez,

Dixon

et al. 2023

JPM

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The majority of breast cancers are oestrogen receptor-positive (ER+). In ER+ cancers, oestrogen acts as a disease driver, so these tumours are likely to be susceptible to endocrine therapy (ET). ET works by blocking the hormone’s synthesis or effect. A significant number of patients diagnosed with breast cancer will have the spread of tumour cells into regional lymph nodes either at the time of diagnosis, or as a recurrence some years later. Patients with node-positive disease have a poorer prognosis and can respond less well to ET. The nodal metastases may be genomically similar or, as is becoming more evident, may differ from the primary tumour. However, nodal metastatic disease is often not assessed, and treatment decisions are almost always based on biomarkers evaluated in the primary tumour. This review will summarise the evidence in the field on ER+, node-positive breast cancer, including diagnosis, treatment, prognosis and predictive tools.

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Same-day discharge pathway for breast cancer surgery in patients aged over 80: A feasibility study

Osório,

Hipólito-Reis,

Almeida

et al. 2023

Journal of Geriatric Oncology

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Can We Successfully De-Escalate Axillary Surgery in Women Aged ≥ 70 Years with Ductal Carcinoma in Situ or Early-Stage Breast Cancer Undergoing Mastectomy?

Cited by 5 publications

References 30 publications

Use of sentinel lymph node biopsy in elderly patients with breast cancer – 10-year experience from a Swiss university hospital

Use of sentinel lymph node biopsy in elderly patients with breast cancer – 10-year experience from a Swiss university hospital

The Role of Nodes and Nodal Assessment in Diagnosis, Treatment and Prediction in ER+, Node-Positive Breast Cancer

Same-day discharge pathway for breast cancer surgery in patients aged over 80: A feasibility study

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