Sentinel lymph node biopsy is a surgery used to confirm whether breast cancer has spread to the lymph nodes in the armpit. Risks for the patient include lymphoedema (swelling caused by lymph node damage), infection, longer operating time, longer recovery and pain after the operation.
This study used BreastSurgANZ Quality Audit (BQA) data to determine if sentinel node biopsy could be safely excluded when treating women over 74 with
- small,
- hormone sensitive (i.e. treatable with hormone therapy),
- HER2 negative (i.e. do not have high levels of HER2 protein which increases cancer growth),
- low grade cancers (i.e. slow to medium paced growth).
The study found that in Australia and New Zealand between 2010 and 2022, 66% of all breast cancer cases entered into the BQA had no cancer in the lymph nodes. When the dataset was restricted to the target group, 94% of cases had no cancer in the lymph nodes. Those with larger, faster-growing, or HER2 positive cancers were more likely to have cancer spread to the nodes.
This means that for women in the target group, sentinel lymph node biopsy may provide little benefit as cancer is unlikely to have spread. Doctors should consider tumour type, overall health and treatment goals before recommending this operation.
Reference:
Grant, K., Po, X. Y., & Tiong, L. (2024). Is routine axillary staging still required in clinically node negative early breast cancer in women over 74 years?. ANZ journal of surgery, 94(12), 2159–2164. https://doi.org/10.1111/ans.19313