Work

The outcome of selective delayed sentinel lymph node biopsy following upfront omission of axillary staging in low-risk invasive breast cancers: a retrospective hypothetical simulated analysis

Year: 2025

Type: article

Abstract: BACKGROUND: Sentinel lymph node biopsy (SLNB) is performed to guide recommendations on adjuvant treatments for invasive breast cancer. However, studies have shown oncological safety without SLNB in low-risk patients. We aimed to determine the clinical benefits of delaying SLNB (d-SLNB), if upfront axillary staging was omitted in patients with low-risk invasive breast cancers. METHODS AND MATERIALS: A retrospective hypothetical simulated analysis. Patients who had breast surgery and SLNB between 2019 and 2021 were included. Patients with low-risk invasive cancers were identified based on preoperative histopathology (≥ 65 years, Luminal A-like, T1, cN0, Grade 1-2). Outcome analyses were based on the Actual clinical management compared to two different hypothetical Scenarios: (A) upfront SLNB omission only, and (B) upfront SLNB omission with d-SLNB. Primary endpoints were proportion of patients suitable for SLNB omission, outcome of d-SLNB and changes in adjuvant treatments. Secondary endpoint was surgical costs. RESULT: Of 712 patients, 205 (30%) had low-risk invasive cancers and eligible for SLNB omission. In Scenario A, 25 (12%) patients with SLN metastases would have understaged. If Scenario B was applied, the false negative rate of axillary staging would reduce from 25 (12%) to 12 (6%) patients, p < 0.001. On average, adjuvant treatments were given to 73% (Actual clinical setting) vs. 27% (Scenario A) vs. 55% (Scenario B), p < 0.001. Based on 100 patients, d-SLNB was associated with an incremental cost of 55,000 EUR per 100 patients. CONCLUSION: Although upfront SLNB omission was associated with missed SLN metastases, majority of low-risk invasive cancers were SLN negative. Delayed-SLNB could provide additional useful information to guide adjuvant treatments.

Source: Discover Oncology

DOI: 10.1007/s12672-025-03344-y

Authors: Albin Bengtsson, Karolina Larsson, Kian Chin

Institutions: Kungälvs Sjukhus, Sahlgrenska University Hospital, University of Gothenburg

Language: English

Topic: Breast Cancer Treatment Studies

Subfield: Cancer Research

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,690