Some elderly breast cancer patients may be spared lymph node evaluation

As our population ages, women over the age of 70 will continue to form a significant proportion of our patient population.  These patients often present unique challenges to clinicians:  they frequently have relatively favorable hormone receptor-positive breast cancers, yet they may have other comorbidities that influence treatment options.  We sought to determine whether a subset of these patients could be predicted to be node-negative, and could therefore be spared axillary node evaluation.  We found that patient age, tumor size, and lymphovascular invasion were independent predictors of lymph node status in this population.  Based on these factors, we created and validated a clinical prediction model to determine the likelihood of lymph node metastases, and defined a population in whom the risk of lymph node metastases is low (less than/equal to 5%).  While most patients will undergo sentinel lymph node biopsy, for patients in whom comorbidities may imply significant risk of this procedure, our model may aid clinicians in predicting risk of lymph node metastases

Bibliographic Reference

Chagpar AB et al.: "Can sentinel node biopsy be avoided in some elderly breast cancer patients?", Ann Surg. 2009 Mar;249(3):455-60

Anees B. Chagpar

Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky, USA