Posted: Friday, April 22, 2022
Sentinel node biopsy may be unnecessary in older women with certain low-risk breast cancers, according to Kyra Nicholson, MD, of NorthShore University HealthSystem and University of Chicago, Evanston, Illinois, and colleagues. In fact, they reported that positive lymph node status may not be a reliable indicator of the need for adjunctive chemotherapy in women with hormone receptor–positive, HER2-negative, clinical stage T1 or T2 breast cancers American Joint Committee on Cancer (AJCC) clinical stage I breast cancer and HER2-negative breast cancer. These study findings were presented at the 2022 Annual Meeting of the American Society of Breast Surgeons (ASBrS).
“We are learning that there is more to tumor biology than just nodal status,” staged study coauthor Katharine Yao, MD, also of NorthShore University HealthSystem, in an ASBrS press release. “For this patient population, consideration of other tumor factors including possibly an Oncotype score may be more useful than nodal status.”
The study used the National Cancer Database to focus on patients older than age 70 with hormone receptor–positive, HER2-negative breast cancers from 2010 to 2018. Enrolled patients were divided into two groups based on Oncotype Dx scores of less than 26 or at least 26. The study compared the distribution of Oncotype scores between pathologic node-positive and node-negative patients.
Of the 28,338 patients enrolled in the study, 5,640 (19.9%) had node-positive disease, and 22,698 (80.1%) had node-negative disease. Overall, the proportion of patients with an Oncotype Dx score of at least 26 was 3,330 (13.1%) for node-negative patients and 740 (14.7%) for node-positive patients. The proportion of patients with Oncotype Dx scores of at least 26 remained stable at 13.1% in 2010 and 13.5% in 2018. Alternatively, scores decreased from 20.0% in 2010 to 15.2% in 2018 in node-positive patients.
The strongest independent factor associated with an Oncotype Dx score of at least 26 was tumor grade 3 for both patients with node-positive and node-negative disease. The second strongest factor was negative progesterone receptor status.
Disclosure: For full disclosures of study authors, visit www.breastsurgeons.org.
2022 American Society of Breast Surgeons Annual Meeting