Data support option to skip sentinel lymph node biopsy in early breast cancer

Editor's Note

Skipping sentinel lymph node biopsy (SLNB) in patients with clinically node-negative early breast cancer provides noninferior outcomes compared to undergoing the procedure, MedPage Today reported December 13.

Presented at the San Antonio Breast Cancer Symposium and published in the New England Journal of Medicine, the INSEMA trial found similar 5-year invasive disease-free survival (IDFS) rates for patients omitting SLNB (91.9%) and those undergoing the procedure (91.7%), the outlet reports.

According to the article, patients who skipped SLNB also experienced fewer complications, including lower rates of lymphedema (1.8% vs 5.7%), restricted arm mobility (2% vs 3.5%), and arm/shoulder pain (2% vs 4.2%). However, the omission was associated with a slightly higher axillary recurrence rate (1% vs 0.3%) but lower mortality (1.4% vs 2.4%).

The findings support de-escalating axillary surgery in select patients over 50 with low-risk tumor characteristics, such as hormone receptor-positive subtypes and tumors no larger than 2 cm, MedPage reports. The results also align with the SOUND trial, which also showed excellent outcomes without SLNB in a similar patient population. However, quoted sources note that SLNB remains essential for staging larger or high-risk tumors and for guiding adjuvant therapies, including chemotherapy and radiotherapy.

According to the article, both trials underline the need for multidisciplinary decision-making to tailor surgical interventions to individual patients, ensuring optimal treatment while minimizing complications. Further trials, including BOOG and NAUTILUS, are underway to refine patient selection and clarify SLNB’s role in breast cancer management.