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Background <p>Recent studies suggest that selective omission of sentinel lymph node biopsy (SLNB) in early-stage breast cancer may reduce morbidity without compromising oncologic outcomes. The impact of SLNB omission on eligibility for adjuvant therapies, including CDK4/6 inhibitors and partial breast irradiation (PBI),&#xa0;remains&#xa0;unclear, as both depend on nodal status.</p> Methods <p>Using a single-institution&#xa0;registry (2012–2024), we&#xa0;identified&#xa0;women with cT1N0, ER+/HER2−, grade 1–2 breast cancer who would&#xa0;have been&#xa0;candidates for SLNB omission. Pathologic nodal status and eligibility for&#xa0;CDK4/6 inhibitors&#xa0;and PBI were assessed.</p> Results <p>Among 1,194 patients, 130 (10.9%) had ≥1 positive sentinel lymph nodes, including five (0.4%) with ≥4 positive nodes. Nodal positivity decreased with age&#xa0;(18%&#xa0;&lt;50&#xa0;years&#xa0;vs.&#xa0;7.4%&#xa0;≥70&#xa0;years&#xa0;(<i>p</i> &lt; 0.001).&#xa0;Nodal positivity increased with tumor size&#xa0;(6.2% (cT1a), 6.6% (cT1b),&#xa0;14.4% (cT1c);&#xa0;<i>p</i> &lt; 0.001)&#xa0;and with tumor grade&#xa0;(8.5% (grade 1)&#xa0;vs.&#xa0;12.4% (grade 2);&#xa0;<i>p</i> = 0.03). In women aged 50–59 years with&#xa0;cT1a/b tumors, nodal positivity&#xa0;did not differ by grade (6.8% grade 1 vs.&#xa0;11.1%&#xa0;grade 2;&#xa0;<i>p</i> = 0.43). In women aged ≥60 years with cT1a/b tumors, rates were 3.1 and 2.1%, respectively (<i>p</i> = 1.00).</p> Conclusions <p>Under current guidelines, SLNB omission would have excluded 18% of women &lt;50 and 8.8% of women ≥50 from consideration for&#xa0;CDK4/6 inhibitors&#xa0;and PBI. Sentinel lymph node biopsy omission is unlikely to affect adjuvant treatment selection in carefully selected older women with small, low-grade tumors, particularly those aged ≥60 years with grade 1 cT1a/b disease, in whom occult nodal positivity was only 2.1%. In contrast, younger patients, those with cT1c tumors, and those with higher-grade disease demonstrated substantially higher rates of nodal involvement, suggesting that SLNB continues to provide clinically actionable information that may influence eligibility for CDK4/6 inhibitors and partial breast irradiation. These findings support a risk-adapted rather than universal approach to SLNB omission.</p>

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Impact of Sentinel Node Omission in Early-Stage Breast Cancers on Adjuvant Therapy Decision-Making

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Jordan E Jackson,
  • Sarah Hartman,
  • Joshua Barkin,
  • Hemi Thaker,
  • Julia Chandler,
  • Michael Alvarado

摘要

Background

Recent studies suggest that selective omission of sentinel lymph node biopsy (SLNB) in early-stage breast cancer may reduce morbidity without compromising oncologic outcomes. The impact of SLNB omission on eligibility for adjuvant therapies, including CDK4/6 inhibitors and partial breast irradiation (PBI), remains unclear, as both depend on nodal status.

Methods

Using a single-institution registry (2012–2024), we identified women with cT1N0, ER+/HER2−, grade 1–2 breast cancer who would have been candidates for SLNB omission. Pathologic nodal status and eligibility for CDK4/6 inhibitors and PBI were assessed.

Results

Among 1,194 patients, 130 (10.9%) had ≥1 positive sentinel lymph nodes, including five (0.4%) with ≥4 positive nodes. Nodal positivity decreased with age (18% <50 years vs. 7.4% ≥70 years (p < 0.001). Nodal positivity increased with tumor size (6.2% (cT1a), 6.6% (cT1b), 14.4% (cT1c); p < 0.001) and with tumor grade (8.5% (grade 1) vs. 12.4% (grade 2); p = 0.03). In women aged 50–59 years with cT1a/b tumors, nodal positivity did not differ by grade (6.8% grade 1 vs. 11.1% grade 2; p = 0.43). In women aged ≥60 years with cT1a/b tumors, rates were 3.1 and 2.1%, respectively (p = 1.00).

Conclusions

Under current guidelines, SLNB omission would have excluded 18% of women <50 and 8.8% of women ≥50 from consideration for CDK4/6 inhibitors and PBI. Sentinel lymph node biopsy omission is unlikely to affect adjuvant treatment selection in carefully selected older women with small, low-grade tumors, particularly those aged ≥60 years with grade 1 cT1a/b disease, in whom occult nodal positivity was only 2.1%. In contrast, younger patients, those with cT1c tumors, and those with higher-grade disease demonstrated substantially higher rates of nodal involvement, suggesting that SLNB continues to provide clinically actionable information that may influence eligibility for CDK4/6 inhibitors and partial breast irradiation. These findings support a risk-adapted rather than universal approach to SLNB omission.