Use of sentinel lymph node biopsy in elderly patients with breast cancer - 10-year experience from a Swiss university hospital

World J Surg Oncol. 2023 Jun 8;21(1):176. doi: 10.1186/s12957-023-03062-1.

Abstract

Background: The Choosing Wisely initiative recommended the omission of routine sentinel lymph node biopsy (SLNB) in patients ≥ 70 years of age, with clinically node-negative, early stage, hormone receptor (HR) positive and human epidermal growth factor receptor 2 (Her2) negative breast cancer in August 2016. Here, we assess the adherence to this recommendation in a Swiss university hospital.

Methods: We conducted a retrospective single center cohort study from a prospectively maintained database. Patients ≥ 18 years of age with node-negative breast cancer were treated between 05/2011 and 03/2022. The primary outcome was the percentage of patients in the Choosing Wisely target group who underwent SLNB before and after the initiative went live. Statistical significance was tested using chi-squared test for categorical and Wilcoxon rank-sum tests for continuous variables.

Results: In total, 586 patients met the inclusion criteria with a median follow-up of 2.7 years. Of these, 163 were ≥ 70 years of age and 79 were eligible for treatment according to the Choosing Wisely recommendations. There was a trend toward a higher rate of SLNB (92.7% vs. 75.0%, p = 0.07) after the Choosing Wisely recommendations were published. In patients ≥ 70 years with invasive disease, fewer received adjuvant radiotherapy after omission of SLNB (6.2% vs. 64.0%, p < 0.001), without differences concerning adjuvant systemic therapy. Both short-term and long-term complication rates after SLNB were low, without differences between elderly patients and those < 70 years.

Conclusions: Choosing Wisely recommendations did not result in a decreased use of SLNB in the elderly at a Swiss university hospital.

Keywords: Axillary staging; Axillary surgery; Breast cancer; Breast cancer surgery; Elderly; Sentinel lymph node biopsy.

MeSH terms

  • Aged
  • Axilla / pathology
  • Breast Neoplasms* / pathology
  • Cohort Studies
  • Female
  • Hospitals
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Retrospective Studies
  • Sentinel Lymph Node Biopsy
  • Sentinel Lymph Node* / pathology
  • Sentinel Lymph Node* / surgery
  • Switzerland / epidemiology