O71: Sentinel Lymph Node Biopsy in Elderly Patients with Early ER+ Breast Cancer: A Systematic Review of the Literature

Abstract

Abstract Purpose In 2016, the Choosing Wisely guidelines recommended that women over 70 years of age with Oestrogen Receptor positive (ER+), HER2-negative (HER2-), early-stage (T1, T2), clinically node-negative (cN0) invasive breast cancer (BC) should not routinely undergo sentinel lymph node biopsy (SLNB). The aim of this systematic review is to analyse subsequent literature on the influence of SLNB on management and outcomes. Methods An electronic search of Medline (OVID), EMBASE and Cochrane Reviews was conducted Studies comparing SLNB vs. no SLNB were included. 4 studies were eligible for final inclusion. Overall survival (OS), breast cancer-specific survival (BCSS) and influence on adjuvant therapy decisions were analysed. Results Chagpar et al. found SLNB was independently associated with significantly better OS (HR=0.633) in 157,584 patients and better BCSS (HR=0.452) in a subset of 116,059 patients compared to no SLNB. In 24,995 patients, Xu et al. found better OS in those who received SLNB (HR= 0.585) and better BCSS (HR=0.864) vs. those who did not. Castelo et al. performed 2 studies: the first included 126,047 patients, worse BCSS was observed in the no-SLNB group (sub-distribution HR=1.17); the second included 6,286 patients, both worse OS (adjusted HR=1.22), and BCSS (adjusted HR=1.08) were also associated with not receiving SLNB. Conclusion Better OS and BCSS were seen in patients who received SLNB vs. no SLNB despite adjusting for confounders across these studies. While some selection bias may have influenced results, clinicians should remain cautious in omitting SLNB in this cohort.