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

Heidinger, Martin; Maggi, Nadia; Dutilh, Gilles; Mueller, Christoph; Eller, Ruth; Loesch, Julie; Schwab, Fabienne D.; Kurzeder, Christian; Weber, Walter

doi:10.1186/s12957-023-03062-1

Cited by 7 publications

(1 citation statement)

References 45 publications

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“…Whilst results from the remaining trials on the omission of SLNB are pending, an important quest will be to integrate these results into real-world practice, as it was repeatedly shown that the Choosing Wisely recommendations were not followed in clinical practice [38][39][40]. Possible reasons for this are the categorization of SLNB as a low-risk procedure, the lost pathological staging information, and the partial lack of compatibility with inclusion criteria in some of the major trials on radiotherapy-omission and hypofractionation [41][42][43][44][45].…”

Section: Patients With Clinically and Imaging Node-negative Breast Ca...mentioning

confidence: 99%

Axillary Surgery for Breast Cancer in 2024

Heidinger,

Weber

2024

Cancers

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Axillary surgery for patients with breast cancer (BC) in 2024 is becoming increasingly specific, moving away from the previous ‘one size fits all’ radical approach. The goal is to spare morbidity whilst maintaining oncologic safety. In the upfront surgery setting, a first landmark randomized controlled trial (RCT) on the omission of any surgical axillary staging in patients with unremarkable clinical examination and axillary ultrasound showed non-inferiority to sentinel lymph node (SLN) biopsy (SLNB). The study population consisted of 87.8% postmenopausal patients with estrogen receptor-positive, human epidermal growth factor receptor 2-negative BC. Patients with clinically node-negative breast cancer and up to two positive SLNs can safely be spared axillary dissection (ALND) even in the context of mastectomy or extranodal extension. In patients enrolled in the TAXIS trial, adjuvant systemic treatment was shown to be similar with or without ALND despite the loss of staging information. After neoadjuvant chemotherapy (NACT), targeted lymph node removal with or without SLNB showed a lower false-negative rate to determine nodal pathological complete response (pCR) compared to SLNB alone. However, oncologic outcomes do not appear to differ in patients with nodal pCR determined by either one of the two concepts, according to a recently published global, retrospective, real-world study. Real-world studies generally have a lower level of evidence than RCTs, but they are feasible quickly and with a large sample size. Another global real-world study provides evidence that even patients with residual isolated tumor cells can be safely spared from ALND. In general, few indications for ALND remain. Three randomized controlled trials are ongoing for patients with clinically node-positive BC in the upfront surgery setting and residual disease after NACT. Pending the results of these trials, ALND remains indicated in these patients.

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Section: Patients With Clinically and Imaging Node-negative Breast Ca...mentioning

confidence: 99%

Axillary Surgery for Breast Cancer in 2024

Heidinger,

Weber

2024

Cancers

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Surgical treatments for older breast cancer patients: A systematic review and meta-analysis of real-world evidence

Lai,

Chen,

Tam

2024

Surgery

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How to Optimize Deimplementation of Sentinel Lymph Node Biopsy?

Dragvoll,

Bofin,

Søiland

et al. 2024

The Breast Journal

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Background. The omission of sentinel lymph node biopsy in low-risk elderly breast cancer patients has been introduced in several guidelines. Despite evidence to support its safety, this recommendation has not been implemented by many clinicians. We have examined two aspects of this recommendation that may explain why sentinel lymph node biopsy continues to be performed in most of these patients. Firstly, we quantified the proportion of patients diagnosed with axillary metastases postoperatively. Secondly, we examined adherence to antihormonal therapy in the same group of patients. Methods. In this single-centre retrospective cohort study, the study population comprised 98 patients with breast cancer. Patients were aged ≥70 years and diagnosed with hormone receptor positive breast cancers less than 20 mm (T1). All patients underwent surgery and were subsequently prescribed five years of adjuvant antihormonal treatment. Results. Axillary lymph node metastases, as confirmed by the postoperative histology report, were seen in 36.3%. Nonadherence was seen in 33.7% of the patients. Primary nonadherence, that is, patients that never collect their first or subsequent prescriptions at the pharmacy, comprised 11.2% of the total study population. Conclusion. The high proportion of axillary metastases demonstrated suggests that clinical examination of the axilla alone is not sufficient in the preoperative assessment of the axilla. The less-than-optimal adherence rates show that adherence in these patients cannot be taken for granted. We suggest that these factors reflect some of the reluctance among clinicians to omit the sentinel lymph node procedure in these patients.

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

Cited by 7 publications

References 45 publications

Axillary Surgery for Breast Cancer in 2024

Axillary Surgery for Breast Cancer in 2024

Surgical treatments for older breast cancer patients: A systematic review and meta-analysis of real-world evidence

How to Optimize Deimplementation of Sentinel Lymph Node Biopsy?

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