Can we forgo sentinel lymph node biopsy in women aged ≥ 50 years with early-stage hormone-receptor-positive HER2-negative special histologic subtype breast cancer? Journal Article

  


Authors: Knape, N.; Park, J. H.; Agala, C. B.; Spanheimer, P.; Morrow, M.; Downs-Canner, S.; Baldwin, X. L.
Article Title: Can we forgo sentinel lymph node biopsy in women aged ≥ 50 years with early-stage hormone-receptor-positive HER2-negative special histologic subtype breast cancer?
Abstract: Background: Breast cancer has significant biologic heterogeneity, which influences treatment decisions. We hypothesized that in postmenopausal women (≥ 50 years) with clinical T1–2, N0, hormone receptor positive (HR+), HER2 negative (HER2−) breast cancer of special histology (mucinous, tubular, cribriform, papillary), information from sentinel lymph node biopsy (SLNB) may not change adjuvant therapy recommendations. Patients and Methods: We constructed a cohort from the National Cancer Database of women aged ≥ 18 years with cT1–2 N0 HR+ HER2− invasive breast cancer. We calculated the frequency of nodal positivity by histology. We measured the frequency of N2/N3 disease, the distribution of Oncotype DX 21-gene assay recurrence score (ODX RS) across special histology by nodal status, and frequency of chemotherapy use by ODX RS and pathologic N stage. Results: In women with cN0 HR+/HER2− special histologic subtype breast cancer, the likelihood of pathologic nodal positivity is less than 5%, and 99.7% of patients had N0 or N1 disease. Among women aged ≥ 50 years with HR+/HER2− special histologic subtype breast cancer, there was low prevalence of high ODX RS > 25 in both N0 and N1 patients (7% overall). Receipt of chemotherapy correlated with Oncotype DX scores as anticipated, with the lowest use in women with a low/intermediate RS (from 2 to 6% for N0 and 6–24% for N1) and the highest use in women with high risk Oncotype scores (from 74 to 92%). Conclusions: Our study suggests that SLNB could potentially be omitted in select postmenopausal women with cT1–2 N0 HR+/HER2− special histologic subtype breast cancer when ODX RS is available. © 2022, Society of Surgical Oncology.
Keywords: adult; controlled study; human tissue; major clinical study; multimodality cancer therapy; chemotherapy, adjuvant; combined modality therapy; cancer staging; sentinel lymph node biopsy; neoplasm recurrence, local; mastectomy; cohort analysis; pathology; breast neoplasms; retrospective study; histology; tumor recurrence; adjuvant chemotherapy; breast tumor; receptors, estrogen; estrogen receptor; breast adenocarcinoma; postmenopause; thyroid papillary carcinoma; lumpectomy; ductal carcinoma; lobular carcinoma; charlson comorbidity index; invasive breast cancer; humans; human; female; article; tubular carcinoma of the breast; icd-o-3; hormone receptor-positive, her2-negative breast cancer; mucinous carcinoma of the breast
Journal Title: Annals of Surgical Oncology
Volume: 30
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2023-02-01
Start Page: 1042
End Page: 1050
Language: English
DOI: 10.1245/s10434-022-12626-6
PUBMED: 36217063
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139719901&doi=10.1245%2fs10434-022-12626-6&partnerID=40&md5=960a165bebcbe3a4acf17e066c928fd8
Notes: Article -- MSK corresponding author is Stephanie Downs-Canner -- Export Date: 1 February 2023 -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Monica Morrow
    772 Morrow
  2. Stephanie Michelle Downs-Canner
    38 Downs-Canner
Related MSK Work