AB145. SOH24AB_179. Assessing factors associated with sentinel lymph node positivity in breast cancer patients over the age of 70 years: is there still a role for axillary staging in select patients?
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AB145. SOH24AB_179. Assessing factors associated with sentinel lymph node positivity in breast cancer patients over the age of 70 years: is there still a role for axillary staging in select patients?

Yareen Agha, Angus Lloyd, Claire Keohane, Michael Boland, Claire Rutherford, Damian McCartan, Ruth Prichard, Denis Evoy, Jane Rothwell

Department of Breast and Endocrine Surgery, St. Vincent’s University Hospital, Dublin, Ireland

Background: International guidelines are increasingly advocating for sentinel lymph node (SLN) omission in early breast cancer patients over 70 years. Studies examining such omission in patients with more aggressive phenotypes [lobular subtype/grade 3/lymphovascular invasion (LVI)] are lacking. The aim was to assess the rate of nodal positivity in these subgroups.

Methods: Retrospective analyses were performed on a prospectively maintained breast cancer database including patients over 70 years at diagnosis from 2010 to 2020. Rate of sentinel lymph node biopsy (SLNB) positivity in subgroups including lobular subtype/grade 3 disease/presence of LVI were assessed and compared to the overall group using Chi2 and Student t-tests.

Results: A total of 458 patients over 70 years underwent breast conserving surgery and SLNB. The median number of sentinel nodes excised was 2 (range: 1–6). Among them, 109/458 (23.8%) patients had nodal metastases [median number of positive sentinel nodes =1 (range: 1–3)]. Patients with LVI were more likely to have SLN metastases (47/134, 35.1%) compared to patients without LVI (Chi2 test; P<0.05). The number of patients with a lobular subtype found to have nodal metastases (14/57, 24.6%) didn’t differ from other subtypes (Chi2 test; P=0.88). The number of patients with grade 3 disease with nodal metastases (41/150, 27.33%) didn’t differ from patients with grade 1 or 2 disease (Chi2 test; P=0.21).

Conclusions: Patients over 70 years with LVI are more likely to have nodal metastases which may impact adjuvant treatment decisions. Other traditionally aggressive features such as grade 3 disease or lobular subtypes don’t have higher rates of SLN positivity. SLNB omission in these subgroups appears to be a reasonable approach.

Keywords: Axillary clearance; breast cancer; lymphovascular invasion (LVI); node positive; sentinel lymph node biopsy (SLNB)

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab145
Cite this abstract as: Agha Y, Lloyd A, Keohane C, Boland M, Rutherford C, McCartan D, Prichard R, Evoy D, Rothwell J. AB145. SOH24AB_179. Assessing factors associated with sentinel lymph node positivity in breast cancer patients over the age of 70 years: is there still a role for axillary staging in select patients? Mesentery Peritoneum 2024;8:AB145.

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