Outcomes After Sentinel Lymph Node Biopsy and Radiotherapy in Older Women With Early-Stage, Estrogen Receptor–Positive Breast Cancer

48 Background: Trial data show that omission of surgical axillary staging does not affect overall survival in women >70 with cT1N0 hormone receptor-positive (HR+) breast cancer, and the Society of Surgical Oncology’s Choosing Wisely recommendations advise against routine use of sentinel lymph node biopsy (SLNB) in patients with early-stage HR+ cancers. Despite this, almost 80% of women eligible for omission still undergo SLNB. We sought to explore oncologists’ perspectives of omission of SLNB in this patient population. Methods: We conducted an exploratory qualitative study using semi-structured telephone interviews with surgical, medical, and radiation breast oncologists throughout North America from 3/2020 to 1/2021. Purposive snowball sampling ensured a range of practice types. Interviews were transcribed and a team trained in qualitative analysis undertook thematic analysis guided by grounded theory to identify emergent themes. Results: Participants included sixteen surgical, six medical, and seven radiation oncologists (55% female) (Table). Overall, while oncologists in all fields expressed acceptance regarding SLNB omission in certain women >70 with cT1N0 HR+ disease, many viewed it as a complex choice based on patient comorbidities, chronologic age, patient preferences, and disease factors. Although patients’ physiologic age and life expectancy were also important decisional factors, almost all participants assessed these subjectively despite knowing that validated tools existed. Most surgeons perceived the data backing the Choosing Wisely recommendation as weak, although knowledge of specific supporting studies was low. While all participants agreed that SLNB omission does not affect survival, several radiation oncologists expressed anxiety about resultant increased regional recurrence risk. In the absence of known nodal status, medical and radiation oncologists stated they were more likely to order additional imaging, rely on OncotypeDX scores to make systemic therapy decisions, add high tangents, and be reluctant to offer partial breast irradiation. Conclusions: While surgeons are aware of the Choosing Wisely recommendation, high SLNB rates in patients eligible for omission may be driven by perceptions of the quality of the supporting data and differing ideas regarding appropriate candidacy for omission. There are downstream effects of SLNB omission on medical and radiation oncology treatment decision making and surgeons should engage in multidisciplinary discussion prior to surgery.[Table: see text]

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303 Sentinel lymph node biopsy and immunohistochemical examination of bone marrow for the detection of isolated tumour cells in early stage breast cancer

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(10)70329-3 ◽

2010 ◽

Vol 8 (3) ◽

pp. 146

Author(s):

M. Solá ◽

M. Margeli ◽

E. Castellà ◽

J.M. Gubern ◽

P. Culell ◽

...

Keyword(s):

Breast Cancer ◽

Bone Marrow ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Early Stage ◽

Lymph Node Biopsy ◽

Immunohistochemical Examination ◽

Node Biopsy ◽

Isolated Tumour Cells

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Sentinel lymph node biopsy in early-stage breast cancer

Metastasis of Breast Cancer - Cancer Metastasis – Biology and Treatment ◽

10.1007/978-1-4020-5867-7_17 ◽

2007 ◽

pp. 333-353

Author(s):

Amit Goyal ◽

Robert E. Mansel

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Early Stage ◽

Lymph Node Biopsy ◽

Early Stage Breast Cancer ◽

Node Biopsy

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Sentinel Lymph Node Biopsy Pathology and 2-Year Postsurgical Recurrence of Breast Cancer in Kenyan Women

Journal of Global Oncology ◽

10.1200/jgo.17.00111 ◽

2018 ◽

pp. 1-7

Author(s):

Nathan R. Brand ◽

Ronald Wasike ◽

Khalid Makhdomi ◽

Rajendra Chauhan ◽

Zahir Moloo ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Lymph Node Biopsy ◽

Stage I ◽

Stage Ii ◽

Node Biopsy

Purpose The goal of this study was to describe the pathologic findings and early follow-up experience of patients who underwent a sentinel lymph node biopsy (SLNB) at Aga Khan University Hospital (AKUH) between 2008 and 2017. Patients and Methods We performed a retrospective analysis of women with breast cancer who underwent an SLNB at AKUH between 2008 and 2017. The SLNB was performed on patients with stage I and stage II breast cancer, and identification of the sentinel lymph node was made by radioactive tracer, blue dye, or both, per availability and surgeon preference. Demographic, surgical, and pathologic data, including immunohistochemistry of the surgical sample for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, were abstracted from the patient records. Follow-up data were available for a subset of patients. Results Between 2008 and 2017, six surgeons performed SLNBs on 138 women, 129 of whom had complete records and were included in the study. Thirty-one of 129 (24%) had a positive SLNB, including 10 of 73 (14%) with stage I and 21 of 56 (38%) with stage II disease. Seventy-eight patients (60%) received systemic adjuvant chemotherapy and 79 (62%) received radiation therapy, and of the 102 patients who were estrogen receptor positive, 86 (85%) received endocrine therapy. Seventy-nine patients were observed for > 2 years, and, of these, four (5.1%) had a regional recurrence. Conclusion The SLNB positivity rates were similar to those of high-income country (HIC) cohorts. However, preliminary data suggest that recurrence rates are elevated at AKUH as compared with those of HIC cohorts, perhaps because of a lower use of radiotherapy and chemotherapy at AKUH compared with HIC cohorts or because of differences in the characteristics of the primary tumor in patients at AKUH as compared with those in HICs.

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