Skip to main content

Advertisement

SpringerLink
Log in

Does Sentinel Lymphadenectomy Improve Staging and Alter Therapy in Elderly Women With Breast Cancer?

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Routine axillary lymph node dissection (ALND) for elderly women with invasive breast cancer has been questioned because it rarely alters therapy yet carries a significant morbidity rate. Sentinel lymphadenectomy (SLND) improves axillary staging and alters therapy in women with T1 breast cancer, but it is not clear whether SLND alters therapy in elderly women with breast cancer.

Methods: A prospective breast cancer data base was used to identify women 70 years old and older who underwent SLND for axillary staging of invasive breast cancer between 1991 and 1998.

Results: There were 75 invasive breast cancers in 73 women. The mean patient age was 74.5 years (range, 70–90 years). Median tumor size was 1.4 cm (range, 0.1– 6.2 cm). Of the 75 tumors, 42 (56%) had favorable primary characteristics; the remaining tumors had unfavorable characteristics. SLND was performed alone in 17 cases (23%) and was followed by completion ALND in 58 cases (77%). Positive lymph nodes were identified in 32 cases (43%); 26 (81.3%) were detected by hematoxylin and eosin stains, and 6 (18.7%) were detected by immunohistochemistry alone. Five patients (6.9%) received adjuvant chemotherapy. Seven patients (9.6%) received axillary/supraclavicular radiation for positive nodes. Ten (13.7%) of 73 patients had obvious alterations in therapy because of axillary nodal status. As a result of SLND, 3 (13.6%) of 22 patients with tumors 1.0 cm or smaller received tamoxifen, and 7 (15%) of 46 patients with tumors between 1.0 and 3.0 cm in size had changes in therapy. When patient and tumor characteristics were analyzed to determine relationships to therapeutic decision-making, nodal status was the variable most significantly associated with changes in therapy (P 5 .0001).

Conclusions: SLND improves axillary staging in elderly women with invasive breast cancer. Results of immunohistochemistry do not alter therapy in this group of individuals (P 5 .6367). In patients with small primary tumors, SLND alters therapy by increasing the number of patients receiving tamoxifen. In addition, SLND affects adjuvant systemic chemotherapy and regional radiotherapy in a significant number of patients with larger tumors, particularly tumors between 1.0 and 3.0 cm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mansour EG, Gray R, Shatila AH, et al. 1989; Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer. N Engl J Med 320:485–9.

    Article  CAS  PubMed  Google Scholar 

  2. Fisher B, Redmond C, Wickerham L, et al. 1989; Systemic therapy in patients with node-negative breast cancer. Ann Intern Med 111:708–12.

    Google Scholar 

  3. Fisher B, Dignam J, Mamounas EP, et al. 1996; Sequential methotrexate and fluorouracil for treatment of node-negative breast cancer patients with estrogen receptor-negative tumors. J Clin Oncol 14:1982–92.

    CAS  PubMed  Google Scholar 

  4. Cady B, Stone MD, Wayne J. 1993; New therapeutic possibilities in primary invasive breast cancer. Ann Surg 3:338–49.

    Article  Google Scholar 

  5. Silverstein MJ, Gierson ED, Waisovan JR, et al. 1994; Axillary lymph node dissection for T1a breast carcinoma: is it indicated? Cancer 73:664–7.

    CAS  PubMed  Google Scholar 

  6. Ivens D, Hoe AL, Podd TJ, et al. 1992; Assessment of morbidity from complete axillary dissection. Br J Cancer 66:136–8.

    CAS  PubMed  Google Scholar 

  7. Lin PP, Allison DC, Wainstock J, et al. 1993; Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol 11:1536–44.

    CAS  PubMed  Google Scholar 

  8. Hladiuk M, Huchcroft S, Temple W, Schnurr BE. 1992; Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates. J Surg Oncol 50:47–52.

    CAS  PubMed  Google Scholar 

  9. Naslund E, Fernstad R, Ekman S, et al. 1996; Breast cancer in women over 75 years: is axillary dissection always necessary? Eur J Surg 162:867–71.

    CAS  PubMed  Google Scholar 

  10. Dees EC, Shulman LN, Souba WW, et al. 1997; Does information from axillary dissection change treatment in clinically node-negative patients with breast cancer: an algorithm for assessment of impact of axillary dissection. Ann Surg 226:279–87.

    CAS  PubMed  Google Scholar 

  11. Feigelson BJ, Acosta JA, Feigelson HS, et al. 1996; T1 breast carcinoma in women 70 years of age and older may not require axillary lymph node dissection. Am J Surg 172:487–9.

    CAS  PubMed  Google Scholar 

  12. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. 1994; Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220:391–401.

    PubMed  CAS  Google Scholar 

  13. Giuliano AE, Dale PS, Turner RR. 1995; Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 222: 394–401.

    CAS  PubMed  Google Scholar 

  14. Turner RR, Ollila DW, Krasne DL, Giuliano AE. 1997; Histopathologic validation of the sentinel node hypothesis for breast carcinoma. Ann Surg 226:271–8.

    Article  CAS  PubMed  Google Scholar 

  15. Ollila DW, Brennan MB, Giuliano AE. 1998; Therapeutic effect of sentinel lymphadenectomy in T1 breast cancer. Arch Surg 133:647–51.

    CAS  PubMed  Google Scholar 

  16. Wazer DE, Erban JK, Robert NJ, et al. 1994; Breast conservation in elderly women for clinically negative axillary lymph nodes without axillary dissection. Cancer 74:878–83.

    CAS  PubMed  Google Scholar 

  17. Von Rueden DG, Sessions SC. 1994; Alternative therapy for elderly patients with breast cancer. Am Surg 60:72–8.

    CAS  PubMed  Google Scholar 

  18. Diab SG, Hilsenbeck SG, de Moor C, et al. 1998; Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy. J Clin Oncol 16: 1655–6.

    CAS  PubMed  Google Scholar 

  19. Ragaz J, Jackson SM, Plenderleith IH, et al. 1993; Can adjuvant locoregional radiotherapy (XRT) reduce systemic recurrences in stage I-II breast cancer patients? 10 year analysis of the British Columbia randomized trial [Abstract]. Proc Am Soc Clin Oncol 12:6.

    Google Scholar 

  20. Vicini FA, Horwitz EM, Lacerna MD, et al. 1997; The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 39:1069–76.

    CAS  PubMed  Google Scholar 

  21. Chu KU, Turner RR, Hansen NM, Brennan MB, Bilchik A, Giuliano AE. 1999; Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 229:536–41.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California

    L. Andrew DiFronzo MD, Nora M. Hansen MD, Stacey L. Stern MS, Meghan B. Brennan RN, BSN & Armando E. Giuliano MD, FACS

  2. John Wayne Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404

    Armando E. Giuliano MD, FACS

Authors
  1. L. Andrew DiFronzo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nora M. Hansen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stacey L. Stern MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meghan B. Brennan RN, BSN
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Armando E. Giuliano MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Armando E. Giuliano MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

DiFronzo, L.A., Hansen, N.M., Stern, S.L. et al. Does Sentinel Lymphadenectomy Improve Staging and Alter Therapy in Elderly Women With Breast Cancer?. Ann Surg Oncol 7, 406–410 (2000). https://doi.org/10.1007/s10434-000-0406-1

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-000-0406-1

Key Words

Search

Navigation