Does sentinel lymphadenectomy improve staging and alter therapy in elderlywomen with breast cancer?

Background: Routine axillary lymph node dissection (ALND) for elderly women with invasive breast cancer has been questioned because it rarely alters t herapy yet carries a significant morbidity rate. Sentinel lymphadenectomy ( SLND) improves axillary staging and alters therapy in women with T1 breast cancer, but it is not clear whether SLND alters therapy in elderly women wi th breast cancer. Methods: A prospective breast cancer data base was used to identify women 7 0 years old and older who underwent SLND for axillary staging of invasive b reast cancer between 1991 and 1948. Results: There were 75 invasive breast cancers in 73 women. The mean patien t age was 74.5 years (range, 70-90 years). Median tumor size was 1.4 cm (ra nge, 0.1-6.2 cm). Of the 75 tumors, 42 (56%) had favorable primary characte ristics; the remaining tumors had unfavorable characteristics. SLND was per formed alone in 17 cases (23%) and was followed by completion ALND in 58 ca ses (77%). Positive lymph nodes were identified in 32 cases (43%); 26 (81.3 %) were detected by hematoxylin and eosin stains, and 6 (18.7%) were detect ed by immunohistochemistry alone. Five patients (6.9%) received adjuvant ch emotherapy. Seven patients (9.6%) received axillary/supraclavicular radiati on for positive nodes. Ten (13.7%) of 73 patients had obvious alterations i n therapy because of axillary nodal status. As a result of SLND, 3 (13.6%) of 22 patients with tumors 1.0 cm or smaller received tamoxifen, and 7 (15% ) of 46 patients with tumors between 1.0 and 3.0 cm in size had changes in therapy. When patient and tumor characteristics were analyzed to determine relationships to therapeutic decision-making, nodal status was the variable most significantly associated with changes in therapy (P = .0001). Conclusions: SLND improves axillary staging in elderly women with invasive breast cancer. Results of immunohistochemistry do not alter therapy in this group of individuals (P = .6367). In patients with small primary tumors, S LND alters therapy by increasing the number of patients receiving tamoxifen . In addition, SLND affects adjuvant systemic chemotherapy and regional rad iotherapy in a significant number of patients with larger tumors, particula rly tumors between 1.0 and 3.0 cm.