T1 breast carcinoma in women 70 years of age and older may not require axillary lymph node dissection

Feigelson, Bruce J.; Acosta, José A.; Feigelson, Heather Spencer; Findley, Andrew; Saunders, Eric L.

doi:10.1016/s0002-9610(96)00249-8

Cited by 36 publications

(14 citation statements)

References 10 publications

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“…Earlier studies have demonstrated that data gained from ALND does not alter treatment recommendations for elderly breast cancer patients, arguing against ALND for this purpose. 24–26 The decision to advise chemotherapy depends not only on axillary lymph node status, which can be gleaned from SLNB, but also on the ER status, tumor grade, patient age, and genomic profile of the tumor (e.g., Oncotype DX). We found, in order of decreasing importance, that younger age, ER− status, CCI, node extent, and ALND were the strongest factors linked to the receipt of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients

Javid

Korde

et al. 2014

Ann Surg Oncol

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Background The role of completion axillary lymph node dissection (ALND) for older women who had sentinel lymph node-positive (SLN+) invasive breast cancer is unclear. We examined factors predictive of ALND and the association between ALND, adjuvant chemotherapy administration, and survival. Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we reviewed records of women age >65 diagnosed with stage I/II breast cancer from 1998–2005. Adjusted Cox proportional hazards and multivariate logistic regression were used to identify patient and disease variables associated with ALND, and assess association between ALND and all-cause and breast cancer-specific survival. Results Among SLN+ patients, 88 % underwent ALND. Earlier diagnosis year, greater nodal involvement, younger age, registry location, and larger tumor size were all associated with a significantly higher likelihood of ALND. The ALND in SLN+ patients was not significantly associated with 5-year breast cancer-specific survival (hazard ratio [HR] 1.22, 95 % confidence interval [CI] 0.76–1.96). The SLN+ patients who underwent ALND were more likely to receive adjuvant chemotherapy (odds ratio [OR] 1.8, 95 % CI 1.45–2.24). However, younger age (OR 18.0, 95 % CI 14.4–23.9), estrogen receptor-negative (ER−) status (OR 4.2, 95 % CI 3.4–5.3), and fewer comorbidities (OR 2.6, 95 % CI 1.7–4.0) were all more strongly linked to receipt of chemotherapy. Conclusions ALND for older patients with SLN+ breast cancer is not associated with improved 5-year all-cause or breast cancer-specific survival. Younger age, fewer comorbidities, and estrogen receptor-negative (ER−) status were more strongly associated with receipt of chemotherapy than ALND. Consideration should be given to omitting ALND in older patients, particularly if findings of ALND will not influence adjuvant therapy decisions.

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Section: Discussionmentioning

confidence: 99%

Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients

Javid

Korde

et al. 2014

Ann Surg Oncol

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“…Obviously, the patients in our study were not suitable for chemotherapy. In addition, it has been reported that in patients 70 years or older with T1 breast cancer, lymphadenectomy can be omitted [28], and that in elderly patients with comorbidities, the prognosis is influenced primarily by their general conditions, rather than by treatment modality [29]. Finally, renounce to axillary staging in the presence of elderly patients with poor surgical risk is in agreement with the Italian guidelines from the "Forza Operativa Nazionale sul Carcinoma Mammario" (FONCaM) [30].…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients

Susini

Nori

Olivieri

et al. 2007

Gynecologic Oncology

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“…These patients require an accurate assessment of the costs (post-operative morbidity) and benefits (pathologic staging of the axilla) related to complete axillary dissection, mostly in small size tumours. Actually, the need to perform an Elective Axillary Lymph Node Dissection in over 70 years-old patients with breast cancer is questioned [53][54][55]. However, sN biopsy might have a relevant role in the therapeutic planning, as suggested by DiFronzo et al [56] who examined 73 patients whose mean age was 74.5 years (range, 70-90 years) undergoing sN biopsy: 10 of 73 patients (13.7%) had obvious alterations in therapy because of axillary status.…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node as a new marker for therapeutic planning in breast cancer patients

Gipponi¹,

Bassetti²,

Canavese³

et al. 2004

Journal of Surgical Oncology

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Sentinel lymphadenectomy can better be accomplished when both procedures (lymphatic mapping with vital blue dye and RGS) are used, because of the significantly higher sN detection rate, although the prediction of axillary lymph node status remains remarkably similar whichever method is used. The intraoperative frozen section examination proved to be rather accurate in predicting the actual pathologic status of the sN, with a negative predictive value of 91.8%; in 35% of patients it allowed sN biopsy and axillary dissection to be performed in a one-stage surgical procedure. Finally, specific clinical and histopathologic features of the primary tumour and sN might be used to tailor the loco-regional and systemic treatment in different clinical settings, such as in ductal carcinoma in-situ (DCIS), early-stage invasive breast cancer, and patients with large breast cancer undergoing neo-adjuvant CT for breast-saving surgery as well as elderly patients with operable breast cancer.

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T1 breast carcinoma in women 70 years of age and older may not require axillary lymph node dissection

Cited by 36 publications

References 10 publications

Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients

Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients

Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients

Sentinel lymph node as a new marker for therapeutic planning in breast cancer patients

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