Senitel node biopsy not a reliable way to diagnose breast cancer

In 2020, there were 2.3 million women diagnosed with breast cancer and 685 000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world's most prevalent cancer.

Sentinel node biopsy has some associated morbidity and is an additional procedure in the operating room. However, it may not provide the necessary information for decision-making about adjuvant chemotherapy, Hispanic women were less likely to have a 21-gene recurrence score rendering them eligible for chemotherapy compared to Black and Asian women.

Breast cancer diagnosis by sentinel node biopsy may not be helpful for adjuvant chemotherapy decisions in some older women with breast cancer, according to a new research presented at the American Society of Breast Surgeons annual meeting, 2022.

Study aimed to assess the correlation between nodal status and the Oncotype Dx 21-gene recurrence score, which reflects a tumor's individual biology and is widely used to aid decisions about adjuvant chemotherapy.

Study used the National Cancer Database, they analyzed 28,338 women aged 70 and older who were treated for HR-positive, HER2-negative, AJCC clinical stage T1-T2 breast cancers between 2010 and 2018.

The results of the study were

• A total of 5,640 women (19.9%) were node positive and 22,698 (80.1%) were node negative.

• Overall, the proportion of women with a 21-gene recurrence score of 26 or greater, which typically indicates that chemotherapy will be beneficial, was similar in node negative and node positive women (13.1% and 14.7%, respectively).

• For both node negative and positive women, grade 3 tumors were associated most strongly with a high 21-gene recurrence score, followed by negative progesterone receptor status.

• Additionally, women with tumors greater than 2 cm and those covered by Medicaid were also more likely to have a cancer recurrence score greater than or equal to 26.

Researchers concluded that "Sentinel node biopsy for women older than age 70 with hormone receptor positive breast cancer is not really helpful for making adjuvant chemotherapy decisions. While eliminating sentinel node biopsy may seem counter-intuitive to some patients, it is not likely to have a major impact on their outcomes".

Reference: https://bit.ly/3E8sQ9W American Society of Breast Surgeons annual meeting, held April 6-10, 2022.