Safety of Omitting SLN Biopsy in Early Breast Cancers

Core Concepts

Omitting SLN biopsy in node-negative breast cancers up to 2 cm with negative preoperative axillary ultrasound results is safe and does not significantly impact outcomes.

Abstract

The study explores the safety of omitting sentinel lymph node (SLN) biopsy in node-negative breast cancers up to 2 cm with negative preoperative axillary ultrasound results. Key points include:

SLN biopsy standard for axillary staging in early breast cancer.
Prospective SOUND trial randomized 1405 women to SLN biopsy or no axillary surgery.
Primary outcome: 5-year distant disease-free survival.
Secondary endpoints: cumulative incidence of distant and axillary recurrences, disease-free survival, and overall survival.
Omitting SLN biopsy did not significantly affect outcomes.
Similar 5-year locoregional relapse rates, distant metastases, and overall survival between groups.
No significant differences in adjuvant treatment recommendations.
Study limitations include short-term follow-up and potential differences in outcomes over a longer period.

Stats

87.8% of patients had ER-positive ERBB2-negative disease.
13.7% of patients in the biopsy group had positive axillary nodes.
3.0% deaths in the SLNB group and 2.6% deaths in the no axillary surgery group.

Quotes

"The results of this trial support the safety of omitting axillary surgery in older postmenopausal women with ER-positive ERBB2-negative [breast cancer] who met the SOUND eligibility criteria."

Key Insights Distilled From

Omitting SLN Biopsy Safe for Some Early Breast Cancers

by Megan Brooks at www.medscape.com 09-25-2023

https://www.medscape.com/viewarticle/996776

Deeper Inquiries

How might the findings of this study impact current clinical practices in breast cancer treatment

The findings of this study could significantly impact current clinical practices in breast cancer treatment by potentially reducing the need for sentinel lymph node biopsy (SLN) in certain cases. If validated and adopted widely, this approach could spare many women from unnecessary invasive procedures and their associated risks, such as lymphedema and nerve damage. It may lead to a more personalized and less aggressive treatment approach, tailored to the individual characteristics of the patient and their cancer. This shift could also result in cost savings for healthcare systems and improve the overall quality of life for patients by avoiding unnecessary interventions.

What potential challenges or criticisms could arise from omitting SLN biopsy in certain cases

Omitting SLN biopsy in certain cases may raise potential challenges or criticisms in the field of breast cancer treatment. One concern could be the risk of missing positive lymph nodes that could impact staging and treatment decisions. Without SLN biopsy, there may be a possibility of understaging some patients, leading to inadequate treatment strategies. Additionally, there could be a lack of consensus among healthcare providers regarding which patients are suitable for omitting SLN biopsy, potentially leading to variability in practice and outcomes. Furthermore, some clinicians and patients may be hesitant to forego a standard procedure like SLN biopsy due to fear of missing important information that could influence treatment decisions.

How can the study's focus on older postmenopausal women with specific breast cancer types influence future research in the field

The study's focus on older postmenopausal women with specific breast cancer types, such as ER-positive ERBB2-negative disease, could influence future research in the field by prompting more tailored and individualized approaches to breast cancer treatment. Future studies may delve deeper into subgroups of breast cancer patients to identify those who can safely omit certain procedures like SLN biopsy without compromising outcomes. This could lead to a more nuanced understanding of breast cancer biology and behavior in different patient populations, guiding the development of personalized treatment strategies. Additionally, researchers may explore the long-term implications of omitting SLN biopsy in specific subgroups to assess any potential differences in outcomes over extended follow-up periods.