Limited impact of sentinel lymph node biopsy in older women with cT2N0 hormone-positive human epidermal growth factor receptor 2-negative breast cancer

Why clinicians should know about it

• Picked for Breast and Endocrine Surgery (paper of the day, 1 October 2026): Sentinel node biopsy rarely influences adjuvant management

Abstract

BACKGROUND: Consensus guidelines support selective omission of sentinel lymph node biopsy for axillary staging in older women with early stage, biologically favorable breast cancer; however, applicability to clinical T2 disease remains unclear. We evaluated the impact of sentinel lymph node biopsy on adjuvant treatment decisions in women ≥65 years with cT2N0 hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. METHODS: A single-institution retrospective review included consecutive patients treated from 2019 to 2023. Clinicopathologic features, adjuvant therapy decisions, and outcomes were analyzed. RESULTS: Among 113 patients, 35 (31%) had pN1 disease, and 2 (1.8%) had pN2-3 disease. Final pathologic tumor size was pT1 in 25 patients (22.1%), 2.1-3.0 cm in 48 (42.5%), 3.1-4.0 cm in 27 (23.9%), and >4.0 cm in 13 (11.5%). Nodal positivity was lower among patients with pT1 compared with pT2 tumors (8% vs 31%, P = .035) but did not differ across pT2 subgroups (P = .864). Twelve patients (10.6%) received chemotherapy, with nodal status determining treatment in only 2 cases. Regional nodal irradiation was administered to 15 of 37 patients with pathologically node-positive disease and omitted in the remainder. At the median follow-up of 3.1 years, 9 patients (8%) experienced recurrence; all pathologically node-positive patients with recurrence (n = 4) demonstrated endocrine therapy noncompliance. CONCLUSION: In women ≥65 years with cT2N0 hormone receptor-positive/human epidermal growth factor receptor-negative breast cancer, sentinel lymph node biopsy infrequently influenced adjuvant management. Chemotherapy was guided by genomic assays, and most patients with pathologically node-positive disease did not receive regional nodal irradiation, supporting a selective, individualized approach to axillary staging.

Abstract as published, via PubMed.