Is breast cancer sentinel lymph node mapping valuable for patients in their seventies and beyond?

Lisa E. McMahon, Richard J. Gray, Barbara A Pockaj

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Axillary lymph node dissection (ALND) is performed less commonly for the axillary staging of elderly patients because it is felt to uncommonly alter therapy. Sentinel lymph node (SLN) dissection can accomplish axillary staging with less morbidity, but it is unclear if it alters subsequent therapy. Methods: Review of a prospectively collected breast cancer SLN mapping database. Medical records were reviewed to supplement the database. Results: Among 730 breast cancer SLN mapping patients, 261 (35.8%) were <70 years of age (range 70 to 95). The overall SLN identification rate was 98.8% among those <70 and 97.1% for those <70 (P = .11) and 100% and 99.4%, respectively (P = .25), among the most recent 500 patients. SLN metastases were detected by hematoxalin and eosin staining (H&E) in 24.2% of those <70 and 13.4% of those <70 (P < .01) and by immunohistochemistry staining (IHC) only in 4.6% and 5.0% of patients, respectively. No elderly patients with histologically negative SLNs underwent ALND, but 88.9% of patients with H&E metastases and 84.6% with IHC metastases underwent ALND. Of the H&E-positive women, 88% underwent adjuvant systemic therapy versus 55% of H&E-negative women (P < .01). Hormonal therapy was administered to 86.9% of SLN-positive women and 54.3% of SLN-negative women (P < .01) and cytotoxic chemotherapy was administered to 24% of SLN-positive patients versus 2.8% of SLN-negative patients (P < .01). SLN status was associated with significantly different rates of systemic therapy for patients with tumors <1 cm and 1 to 2 cm, but not with tumors >2 cm. Mean follow-up was 15.4 months. No patient experienced local or regional recurrence. Distant metastases occurred in 8.2% of patients with SLN metastases and in no patients with negative SLNs (P < .01). Conclusions: The results of SLN mapping and biopsy in elderly patients significantly influences subsequent therapy decisions, including ALND, hormonal therapy, and cytotoxic chemotherapy. SLN biopsy should be recommended to elderly breast cancer patients.

Original languageEnglish (US)
Pages (from-to)366-370
Number of pages5
JournalAmerican Journal of Surgery
Volume190
Issue number3
DOIs
StatePublished - Sep 2005

Fingerprint

Breast Neoplasms
Lymph Node Excision
Sentinel Lymph Node Biopsy
Databases
Neoplasm Metastasis
Therapeutics
Sentinel Lymph Node
Medical Records
Morbidity
Recurrence
Drug Therapy

Keywords

  • Axillary lymph node dissection
  • Breast cancer
  • Elderly
  • Sentinel lymph node biopsy

ASJC Scopus subject areas

  • Surgery

Cite this

Is breast cancer sentinel lymph node mapping valuable for patients in their seventies and beyond? / McMahon, Lisa E.; Gray, Richard J.; Pockaj, Barbara A.

In: American Journal of Surgery, Vol. 190, No. 3, 09.2005, p. 366-370.

Research output: Contribution to journalArticle

@article{53f932ef8ce5404eb69d7d0f471f84ea,
title = "Is breast cancer sentinel lymph node mapping valuable for patients in their seventies and beyond?",
abstract = "Background: Axillary lymph node dissection (ALND) is performed less commonly for the axillary staging of elderly patients because it is felt to uncommonly alter therapy. Sentinel lymph node (SLN) dissection can accomplish axillary staging with less morbidity, but it is unclear if it alters subsequent therapy. Methods: Review of a prospectively collected breast cancer SLN mapping database. Medical records were reviewed to supplement the database. Results: Among 730 breast cancer SLN mapping patients, 261 (35.8{\%}) were <70 years of age (range 70 to 95). The overall SLN identification rate was 98.8{\%} among those <70 and 97.1{\%} for those <70 (P = .11) and 100{\%} and 99.4{\%}, respectively (P = .25), among the most recent 500 patients. SLN metastases were detected by hematoxalin and eosin staining (H&E) in 24.2{\%} of those <70 and 13.4{\%} of those <70 (P < .01) and by immunohistochemistry staining (IHC) only in 4.6{\%} and 5.0{\%} of patients, respectively. No elderly patients with histologically negative SLNs underwent ALND, but 88.9{\%} of patients with H&E metastases and 84.6{\%} with IHC metastases underwent ALND. Of the H&E-positive women, 88{\%} underwent adjuvant systemic therapy versus 55{\%} of H&E-negative women (P < .01). Hormonal therapy was administered to 86.9{\%} of SLN-positive women and 54.3{\%} of SLN-negative women (P < .01) and cytotoxic chemotherapy was administered to 24{\%} of SLN-positive patients versus 2.8{\%} of SLN-negative patients (P < .01). SLN status was associated with significantly different rates of systemic therapy for patients with tumors <1 cm and 1 to 2 cm, but not with tumors >2 cm. Mean follow-up was 15.4 months. No patient experienced local or regional recurrence. Distant metastases occurred in 8.2{\%} of patients with SLN metastases and in no patients with negative SLNs (P < .01). Conclusions: The results of SLN mapping and biopsy in elderly patients significantly influences subsequent therapy decisions, including ALND, hormonal therapy, and cytotoxic chemotherapy. SLN biopsy should be recommended to elderly breast cancer patients.",
keywords = "Axillary lymph node dissection, Breast cancer, Elderly, Sentinel lymph node biopsy",
author = "McMahon, {Lisa E.} and Gray, {Richard J.} and Pockaj, {Barbara A}",
year = "2005",
month = "9",
doi = "10.1016/j.amjsurg.2005.03.028",
language = "English (US)",
volume = "190",
pages = "366--370",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Is breast cancer sentinel lymph node mapping valuable for patients in their seventies and beyond?

AU - McMahon, Lisa E.

AU - Gray, Richard J.

AU - Pockaj, Barbara A

PY - 2005/9

Y1 - 2005/9

N2 - Background: Axillary lymph node dissection (ALND) is performed less commonly for the axillary staging of elderly patients because it is felt to uncommonly alter therapy. Sentinel lymph node (SLN) dissection can accomplish axillary staging with less morbidity, but it is unclear if it alters subsequent therapy. Methods: Review of a prospectively collected breast cancer SLN mapping database. Medical records were reviewed to supplement the database. Results: Among 730 breast cancer SLN mapping patients, 261 (35.8%) were <70 years of age (range 70 to 95). The overall SLN identification rate was 98.8% among those <70 and 97.1% for those <70 (P = .11) and 100% and 99.4%, respectively (P = .25), among the most recent 500 patients. SLN metastases were detected by hematoxalin and eosin staining (H&E) in 24.2% of those <70 and 13.4% of those <70 (P < .01) and by immunohistochemistry staining (IHC) only in 4.6% and 5.0% of patients, respectively. No elderly patients with histologically negative SLNs underwent ALND, but 88.9% of patients with H&E metastases and 84.6% with IHC metastases underwent ALND. Of the H&E-positive women, 88% underwent adjuvant systemic therapy versus 55% of H&E-negative women (P < .01). Hormonal therapy was administered to 86.9% of SLN-positive women and 54.3% of SLN-negative women (P < .01) and cytotoxic chemotherapy was administered to 24% of SLN-positive patients versus 2.8% of SLN-negative patients (P < .01). SLN status was associated with significantly different rates of systemic therapy for patients with tumors <1 cm and 1 to 2 cm, but not with tumors >2 cm. Mean follow-up was 15.4 months. No patient experienced local or regional recurrence. Distant metastases occurred in 8.2% of patients with SLN metastases and in no patients with negative SLNs (P < .01). Conclusions: The results of SLN mapping and biopsy in elderly patients significantly influences subsequent therapy decisions, including ALND, hormonal therapy, and cytotoxic chemotherapy. SLN biopsy should be recommended to elderly breast cancer patients.

AB - Background: Axillary lymph node dissection (ALND) is performed less commonly for the axillary staging of elderly patients because it is felt to uncommonly alter therapy. Sentinel lymph node (SLN) dissection can accomplish axillary staging with less morbidity, but it is unclear if it alters subsequent therapy. Methods: Review of a prospectively collected breast cancer SLN mapping database. Medical records were reviewed to supplement the database. Results: Among 730 breast cancer SLN mapping patients, 261 (35.8%) were <70 years of age (range 70 to 95). The overall SLN identification rate was 98.8% among those <70 and 97.1% for those <70 (P = .11) and 100% and 99.4%, respectively (P = .25), among the most recent 500 patients. SLN metastases were detected by hematoxalin and eosin staining (H&E) in 24.2% of those <70 and 13.4% of those <70 (P < .01) and by immunohistochemistry staining (IHC) only in 4.6% and 5.0% of patients, respectively. No elderly patients with histologically negative SLNs underwent ALND, but 88.9% of patients with H&E metastases and 84.6% with IHC metastases underwent ALND. Of the H&E-positive women, 88% underwent adjuvant systemic therapy versus 55% of H&E-negative women (P < .01). Hormonal therapy was administered to 86.9% of SLN-positive women and 54.3% of SLN-negative women (P < .01) and cytotoxic chemotherapy was administered to 24% of SLN-positive patients versus 2.8% of SLN-negative patients (P < .01). SLN status was associated with significantly different rates of systemic therapy for patients with tumors <1 cm and 1 to 2 cm, but not with tumors >2 cm. Mean follow-up was 15.4 months. No patient experienced local or regional recurrence. Distant metastases occurred in 8.2% of patients with SLN metastases and in no patients with negative SLNs (P < .01). Conclusions: The results of SLN mapping and biopsy in elderly patients significantly influences subsequent therapy decisions, including ALND, hormonal therapy, and cytotoxic chemotherapy. SLN biopsy should be recommended to elderly breast cancer patients.

KW - Axillary lymph node dissection

KW - Breast cancer

KW - Elderly

KW - Sentinel lymph node biopsy

UR - http://www.scopus.com/inward/record.url?scp=23744478629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23744478629&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2005.03.028

DO - 10.1016/j.amjsurg.2005.03.028

M3 - Article

C2 - 16105520

AN - SCOPUS:23744478629

VL - 190

SP - 366

EP - 370

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 3

ER -