Evaluating the Necessity for Routine Sentinel Lymph Node Biopsy in Postmenopausal Patients Being Treated for Clinically Node Negative Breast Cancer the Era of RxPONDER

Matthew G Davey; Eoin P Kerin; Ray P McLaughlin; Michael K Barry; Carmel M Malone; Sami Abd Elwahab; Aoife J Lowery; Michael J Kerin

doi:10.1016/j.clbc.2023.03.011

Evaluating the Necessity for Routine Sentinel Lymph Node Biopsy in Postmenopausal Patients Being Treated for Clinically Node Negative Breast Cancer the Era of RxPONDER

Clin Breast Cancer. 2023 Jul;23(5):500-507. doi: 10.1016/j.clbc.2023.03.011. Epub 2023 Mar 30.

Authors

Matthew G Davey¹, Eoin P Kerin², Ray P McLaughlin³, Michael K Barry³, Carmel M Malone³, Sami Abd Elwahab⁴, Aoife J Lowery⁴, Michael J Kerin⁴

Affiliations

¹ Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland. Electronic address: m.davey7@nuigalway.ie.
² Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland.
³ Department of Surgery, Galway University Hospitals, Galway, Ireland.
⁴ Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland.

PMID: 37076364
DOI: 10.1016/j.clbc.2023.03.011

Abstract

Introduction: Traditionally, sentinel lymph node biopsy (SLNB) was performed to inform adjuvant chemotherapy prescription and prognosis in breast cancer. Following RxPONDER, the OncotypeDX Recurrence Score (RS) guides adjuvant chemotherapy prescription for all postmenopausal patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative (ER+/HER2-) breast cancer with 0 to 3 positive lymph nodes (0-3 + LN).

Aims: To establish the oncological safety of omitting SLNB in postmenopausal patients with ER+/HER2- breast cancer indicated to undergo SLNB and to evaluate the primary determinants of chemotherapy prescription for these patients.

Patients and methods: A retrospective cohort study was undertaken. Cox regression and Kaplan-Meier analyses were performed. Data analytics was performed using SPSS v26.0.

Results: Five hundred and seventy five consecutive patients were included (mean age: 66.5 years, range: 45-96). The median follow-up was 97.2 months (range: 3.0-181.6). Of the 575 patients, just 12 patients had positive SLNB (SLNB+) (2.1%). Using Kaplan-Meier analyses, SLNB+ failed to impact recurrence (P = .766) or mortality (P = .310). However, using Cox regression analyses, SLNB+ independently predicted poorer disease-free survival (hazard ratio: 1.001, 95% confidence interval (95% CI): 1.000-1.001, P = .029). Logistic regression analysis identified RS as the sole predictor of chemotherapy prescription (odds ratio: 1.171, 95% CI: 1.097-1.250, P < .001).

Conclusion: Omitting SLNB may be safe and justifiable in postmenopausal patients with ER+/HER2- breast cancer with clinically negative axillae. Following RxPONDER, RS is the most important guide of chemotherapy use in these patients and SLNB may be less important than previously perceived. Prospective, randomized clinical trials are required to fully establish the oncological safety of omitting SLNB in this setting.

Keywords: Cancer surgery; Genomic profiling; Oncological outcomes; Personalized medicine; Surgical oncology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Axilla / pathology
Breast Neoplasms* / drug therapy
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Female
Humans
Lymph Node Excision
Lymph Nodes / pathology
Postmenopause
Prospective Studies
Retrospective Studies
Sentinel Lymph Node Biopsy
Sentinel Lymph Node* / pathology