Risk Stratification for Sentinel Lymph Node Positivity in Older Women With Early-Stage Estrogen Receptor-Positive/Human Epidermal Growth Factor Receptor 2 Neu-Negative Invasive Breast Cancer.
| Title: | Risk Stratification for Sentinel Lymph Node Positivity in Older Women With Early-Stage Estrogen Receptor-Positive/Human Epidermal Growth Factor Receptor 2 Neu-Negative Invasive Breast Cancer. |
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| Authors: | Wang T; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Neish D; Duke Cancer Institute, Duke University, Durham, NC.; Thomas SM; Duke Cancer Institute, Duke University, Durham, NC.; Biostatistics and Bioinformatics, Duke University, Durham, NC.; Botty van den Bruele A; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Rosenberger LH; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Chiba A; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Modell Parrish KJ; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; DiNome ML; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Dossett LA; Department of Surgery, Michigan Medicine, Ann Arbor, MI.; Scales CD Jr; Department of Urology, Duke University Medical Center, Durham, NC.; Department of Population Health Sciences, Duke University Medical Center, Durham, NC.; Zullig LL; Department of Population Health Sciences, Duke University Medical Center, Durham, NC.; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.; Hwang ES; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Plichta JK; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC.; Department of Urology, Duke University Medical Center, Durham, NC. |
| Source: | JCO clinical cancer informatics [JCO Clin Cancer Inform] 2025 Mar; Vol. 9, pp. e2400186. Date of Electronic Publication: 2025 Mar 26. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: American Society of Clinical Oncology Country of Publication: United States NLM ID: 101708809 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2473-4276 (Electronic) Linking ISSN: 24734276 NLM ISO Abbreviation: JCO Clin Cancer Inform Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Alexandria, VA : American Society of Clinical Oncology, [2017]- |
| MeSH Terms: | Breast Neoplasms*/pathology ; Breast Neoplasms*/metabolism ; Breast Neoplasms*/surgery ; Erb-b2 Receptor Tyrosine Kinases*/metabolism ; Receptors, Estrogen*/metabolism ; Sentinel Lymph Node*/pathology ; Sentinel Lymph Node*/surgery ; Sentinel Lymph Node Biopsy*; Humans ; Female ; Aged ; Retrospective Studies ; Risk Assessment ; Neoplasm Staging ; Aged, 80 and over ; Lymphatic Metastasis ; Neoplasm Invasiveness |
| Abstract: | Purpose: Guidelines recommend omission of sentinel lymph node biopsy (SLNB) for axillary staging in select patients age 70 years and older with early-stage estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 neu-negative (HER2-) invasive breast cancers (BCs). However, many women meeting criteria for SLNB omission continue to receive this procedure. This study aims to stratify patients into risk cohorts for nodal positivity that can be incorporated into deimplementation strategies to reduce low-value SLNB procedures.; Methods: A retrospective cohort analysis using the National Cancer Database was performed on patients age 70 years and older with ER+/HER2-, cT1-2, cN0, cM0 BC who underwent breast surgery from 2018 to 2021. Patients who received neoadjuvant therapies were excluded. Recursive partitioning analysis (RPA) was used to develop two models to estimate nodal positivity: (1) a clinical model for preoperative use to decide whether to perform SLNB and (2) a pathologic model for postoperative use to guide adjuvant decisions in cases of SLNB omission.; Results: The study included 68,867 patients who received SLNB; 13.4% had a tumor-involved lymph node. RPA on the basis of clinical covariates demonstrated |
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| Grant Information: | K12 AR084231 United States AR NIAMS NIH HHS; P30 CA014236 United States CA NCI NIH HHS |
| Substance Nomenclature: | EC 2.7.10.1 (Erb-b2 Receptor Tyrosine Kinases); 0 (Receptors, Estrogen); EC 2.7.10.1 (ERBB2 protein, human) |
| Entry Date(s): | Date Created: 20250326 Date Completed: 20250514 Latest Revision: 20260327 |
| Update Code: | 20260402 |
| PubMed Central ID: | PMC12087273 |
| DOI: | 10.1200/CCI-24-00186 |
| PMID: | 40138607 |
| Database: | MEDLINE |
Journal Article