Castillejos Ibáñez Francisco, Muñoz Sornosa Ernesto, López Flor Vicente, Adrianzén Vargas Marcos, Martínez Martínez María Teresa, Buch Villa Elvira
Breast Unit, Department of General and Digestive Surgery, Hospital Clinico Universitario of Valencia, Department of Surgery, University of Valencia, Biomedical Research Institute, INCLIVA. Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
Department of Medical Oncology, Hospital Clinico Universitario of Valencia, Department of Medicine, University of Valencia, Biomedical Research Institute, INCLIVA. Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
Cancers (Basel). 2025 Aug 24;17(17):2758. doi: 10.3390/cancers17172758.
Sentinel lymph node biopsy (SLNB) has traditionally been used to stage the axilla in early-stage breast cancer. However, its utility in women over 70 with hormone receptor-positive tumors and negative axillary imaging is increasingly questioned due to limited therapeutic benefit and potential complications.
To assess the feasibility of omitting SLNB in women aged 70 and older with clinically node-negative, luminal-type breast cancer.
A retrospective analysis was conducted on women aged 70 and above with histologically confirmed invasive breast cancer, negative axillary imaging, and surgery between January 2021 and December 2024. Eligible patients were selected based on normal axillary ultrasound findings. All underwent SLNB. We examined demographics, clinical characteristics, surgical outcomes, and oncological variables such as recurrence and mortality.
A total of 149 women underwent surgery, with a mean age of 77.2 (5.24) years. SLNB was positive in 23.5% of cases, but only 6.7% required axillary dissection. Sensitivity and specificity of SLNB declined notably after age 76. No axillary or breast recurrences were reported. Most patients (89.9%) received hormonal therapy, while 11.4% had chemotherapy and 17.5% axillary radiotherapy. Outpatient management was feasible in 87.9% of cases, and no clinically significant lymphedema was observed.
Omitting SLNB in women ≥70 years with luminal breast cancer and negative axillary imaging appears safe and does not compromise oncological outcomes. This strategy minimizes surgical risks and enhances quality of life, supporting a more tailored and less invasive approach to axillary management in older patients.
前哨淋巴结活检（SLNB）传统上用于早期乳腺癌腋窝分期。然而，由于治疗益处有限和潜在并发症，其在70岁以上激素受体阳性肿瘤且腋窝影像学检查阴性的女性中的应用越来越受到质疑。
评估在70岁及以上临床腋窝淋巴结阴性的腔隙型乳腺癌女性中省略前哨淋巴结活检的可行性。
对2021年1月至2024年12月期间年龄在70岁及以上、组织学确诊为浸润性乳腺癌、腋窝影像学检查阴性且接受手术的女性进行回顾性分析。根据腋窝超声检查结果正常选择符合条件的患者。所有患者均接受前哨淋巴结活检。我们检查了人口统计学、临床特征、手术结果以及复发和死亡率等肿瘤学变量。
共有149名女性接受了手术，平均年龄为77.2（5.24）岁。前哨淋巴结活检阳性率为23.5%，但仅6.7%的患者需要进行腋窝清扫。76岁以后前哨淋巴结活检的敏感性和特异性显著下降。未报告腋窝或乳腺复发。大多数患者（89.9%）接受了激素治疗，11.4%接受了化疗，17.5%接受了腋窝放疗。87.9%的病例可行门诊管理，未观察到具有临床意义的淋巴水肿。
对于70岁及以上腔隙型乳腺癌且腋窝影像学检查阴性的女性，省略前哨淋巴结活检似乎是安全的，且不影响肿瘤学结局。该策略可将手术风险降至最低并提高生活质量，支持对老年患者腋窝管理采取更具针对性且侵入性更小的方法。
