Is management of the positive sentinel node different in elderly patients with breast cancer?
Introduction: This study was undertaken to determine whether management of patients with positive sentinel nodes was affected by age at diagnosis. Methods: From July 1997 to February 2001. 2441 patients <70 years of age and 492 patients 70 years or older with clinically node-negative breast cancer underwent sentinel lymph node biopsy utilizing both blue dye and technetium-99m sulfur colloid. Each sentinel lymph node (SLN) underwent enhanced pathology by serial sectioning and immunohistochemistry. Results: The SLN was positive in 825 patients; of these. 281 were detected by enhanced pathology alone. In a comparison of the age groups ≥70 years and <70, the SLN was found less often by blue dye (81% vs. 84%, p=0.05) and by isotope (89% vs. 92%, p = 0.03) in patients 270 years, but overall (dye and/or isotope) success was comparable for the two groups (97% vs. 98%, p=NS). Completion ALND in patients with positive SLN Age Group SLN + ALND done Enhanced path+ SLN+ ALND done/ Enhanced path+ <70 714/2441 (29%) 633/714 (88%) 243/714 (34%) 175/243 (72%) ≥70 111/492(23%) 85/111 (77%) 38/111 (34%) 17/38 (45%) p-value 0.002 0.001 NS 0.001 Conclusion: The SLNB procedure is equally successful in patients 70 years or older and those less than 70; however, in elderly patients (≥70). the positive sentinel node is less likely to be managed with a completion ALND, regardless of the method of detection.