Lymph Node Staging in Breast Cancer in Patients Greater Than 70 Years of Age

  • Triple-negative breast cancer:
    • Is more responsive to preoperative chemotherapy compared to ER/PR+, HER2neu negative breast cancer:
      • Pathologic complete response is seen in approximately 30% to 40% of patients undergoing treatment with a third-generation regimen:
        • A pathologic complete response:
          • Is highly prognostic in this subset
  • While ER negative breast cancers:
    • Have a lower propensity for regional nodal metastasis compared to ER+ tumors:
      • The difference is relatively small (2% to 5%):
        • Therefore, nodal staging is still a standard practice recommendation
  • The Choosing Wisely guideline:
    • For omission of routine use of sentinel node biopsy in clinically node-negative women ≥ 70 years of age applies to hormone receptor positive breast cancer
  • Sentinel node biopsy may be successfully performed after neoadjuvant chemotherapy and should be performed patients with a clinically negative axilla
  • References
    • Cortazar P, Zhang L, Untch M, et al. Pathologic complete response and long term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-172.
    • Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25(28):4414-4422.
    • von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796-1804.
    • Viale G, Zurrida S, Maiorano E, et al. Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution. Cancer. 2005;103(3):492-500.
    • Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31(19):2382-2387.

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