Background: Sentinel lymph node biopsy (SLNB) has traditionally been used to stage the axilla in early-stage breast cancer. However, its utility in women over 70 with hormone receptor-positive tumors and negative axillary imaging is increasingly questioned due to limited therapeutic benefit and potential complications. Objectives. To assess the feasibility of omitting SLNB in women aged 70 and older with clinically node-negative, luminal-type breast cancer. Methods: A retrospective analysis was conducted on women aged 70 and above with histologically confirmed invasive breast cancer, negative axillary imaging, and surgery between January 2021 and December 2024. Eligible patients were selected based on normal axillary ultrasound findings. All underwent SLNB. We examined demographics, clinical characteristics, surgical outcomes, and oncological variables such as recurrence and mortality. Results: A total of 149 women underwent surgery, with a mean age of 77.2 (5.24) years. SLNB was positive in 23.5% of cases, but only 6.7% required axillary dissection. Sensitivity and specificity of SLNB declined notably after age 76. No axillary or breast recurrences were reported. Most patients (89.9%) received hormonal therapy, while 11.4% had chemotherapy and 17.5% axillary radiotherapy. Outpatient management was feasible in 87.9% of cases, and no clinically significant lymphedema was observed. Conclusions: Omitting SLNB in women ≥70 years with luminal breast cancer and negative axillary imaging appears safe and does not compromise oncological outcomes. This strategy minimizes surgical risks and enhances quality of life, supporting a more tailored and less invasive approach to axillary management in older patients.
背景：前哨淋巴结活检（SLNB）传统上用于早期乳腺癌的腋窝分期。然而，对于70岁以上、激素受体阳性且腋窝影像学阴性的女性患者，由于治疗获益有限及潜在并发症，其应用价值日益受到质疑。目的：评估在70岁及以上临床淋巴结阴性、管腔型乳腺癌女性患者中省略SLNB的可行性。方法：对2021年1月至2024年12月期间接受手术、经组织学确诊为浸润性乳腺癌、腋窝影像学阴性且年龄≥70岁的女性患者进行回顾性分析。根据腋窝超声检查结果正常筛选合格患者。所有患者均接受SLNB。我们分析了人口统计学特征、临床特点、手术结果以及复发和死亡率等肿瘤学变量。结果：共149例女性患者接受手术，平均年龄77.2（5.24）岁。SLNB阳性率为23.5%，但仅6.7%需要腋窝清扫。76岁后SLNB的敏感性和特异性显著下降。未报告腋窝或乳腺复发。大多数患者（89.9%）接受激素治疗，11.4%接受化疗，17.5%接受腋窝放疗。87.9%的病例可实现门诊管理，未观察到临床显著淋巴水肿。结论：对于≥70岁、管腔型乳腺癌且腋窝影像学阴性的女性患者，省略SLNB似乎是安全的，且不影响肿瘤学结局。该策略可最大限度降低手术风险并提高生活质量，支持对老年患者腋窝管理采取更个体化、微创化的方法。
肿瘤(癌症)患者之家