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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2018

01-10-2018 | Breast Oncology

ASBRS Great Debate: Sentinel Node Biopsy in Patients Over 70 Years of Age

Authors: Sarah L. Blair, MD, Catherine Tsai, MD, Lorraine Tafra, MD

Published in: Annals of Surgical Oncology | Issue 10/2018

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Abstract

Introduction

Controversy over the need for sentinel node biopsy (SNB) continues to exist for the optimal treatment of breast cancer in patients ≥ 70 years of age, especially in those with lower-risk disease. Clinicians must balance competing risks to give the best individualized care.

Methods

The American Society of Breast Surgeons (ASBrS) conducted a debate discussing the pros and cons of routinely performing SNB in this age group. Small, randomized studies have been conducted that show no overall survival benefit to axillary intervention (either axillary dissection or SNB) in patients with clinically T1N0 estrogen receptor (ER)- and progesterone receptor (PR)-positive, HER2/neu-negative tumors. There may be a small local recurrence benefit to axillary staging in patients who do not undergo radiation. Alternatively, axillary ultrasound, which carries a low false-negative rate for heavy disease burden, can be used to select patients who can avoid SNB.

Conclusion

Surgeons must continue to individualize care of breast cancer patients over 70 years of age in whom competing comorbidities may dictate care. No randomized clinical trials (RCTs) have found a survival benefit to axillary staging in this low-risk population. However, in healthy patients, axillary staging may improve local control, provide prognostic information, and help guide decisions regarding adjuvant therapy such as chemotherapy and radiation. Ongoing RCTs are evaluating the benefit of SNB in patients with a negative axillary ultrasound. Until those results are available, clinicians and patients must balance the risk and benefits to determine if SNB adds significant value to their overall care.
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Metadata
Title
ASBRS Great Debate: Sentinel Node Biopsy in Patients Over 70 Years of Age
Authors
Sarah L. Blair, MD
Catherine Tsai, MD
Lorraine Tafra, MD
Publication date
01-10-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6617-0

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