Limited Impact of Sentinel Lymph Node Biopsy in Older Women with cT2N0 Hormone-Positive HER2-Negative Breast Cancer

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Consensus guidelines recommend selective use of sentinel node biopsy (SNB) for axillary staging in older women with early breast cancer and favorable tumor biology. Applicability of this to clinical T2 tumors remains unclear. This study examined how often SNB influenced adjuvant treatment decisions in women 65 years or older with clinical T2N0 hormone-positive (HR+) HER2 negative disease.

A single-institution retrospective review identified consecutive patients treated from 2019-2023. Clinicopathologic features, adjuvant therapy decisions, and outcomes were analyzed.

Among 113 patients included, 35 (31%) were pN1 and 2 (1.8%) were pN2. Tumor sizes included 25 (22.1%) downstaged to pT1, 48 (42.5%) measuring 2.1-3 cm, 27 (23.9%) measuring 3.1-4 cm, and 13 (11.5%) >4 cm. Nodal positivity was significantly lower for pT1 tumors (n=2; 8%, p=0.035) but did not differ among pT2 subgroups (39.6% vs 37% vs 46.2% respectively, p=0.864). Of 12 (10.6%) patients who received chemotherapy, nodal status was the deciding factor in only 2 cases, with multigene assay results guiding the remainder. Regional nodal irradiation (RNI) was administered to 15 (13.3%) patients, but was omitted for the majority (n=22) of pN+ cases. Among pN+ patients, recurrence rates were13.3% with RNI (n=2/15) and 9.1% without (n=2/15 and n=2/22, respectively, p=0.207). At a median follow-up of 3.1 years (range 0.1-6.3), 9 (8%) patients experienced recurrence (5 pN0, 4 pN+), and 4 (3.5%) died of breast cancer (2 pN0, 2 pN+). Endocrine noncompliance was noted in the 4 pN+ patients with recurrences.

In women 65 years or older with cT2N0 HR+/HER2- breast cancer, SNB infrequently altered adjuvant management. Chemotherapy decisions were primarily guided by genomic assays, and most node-positive patients did not receive RNI. These findings support a more selective approach to SNB in this population, emphasizing individualized decision-making over routine axillary staging.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1899

This document is currently not available here.

Share

COinS