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Abstract
Introduction. The necessity of sentinel lymph node biopsy (SLNB) in patients with early breast cancer (BC) and clinically negative lymph nodes (cN0) has been debated since the publication of the ACOSOG Z0011 trial data (2010). Contemporary randomized trials (SOUND, INSEMA, BOOG 2013-08) are evaluating the safety of omitting SLNB in patients undergoing breast-conserving surgery (BCS) with pre- or postoperative chemotherapy and radiotherapy.
Aim. To compare the long-term outcomes in patients with cN0-pN0 breast cancer treated with and without SLNB.
Materials and Methods. The study conducted at the P.A. Herzen National Medical Research Center of Oncology (2017-2022) included 204 patients with luminal subtypes of primary operable breast cancer (cT1-2N0). Group I comprised 51 patients who underwent no surgical intervention on regional lymph nodes, followed by radiotherapy. Group II consisted of 153 patients, selected by propensity score matching (3:1 ratio), who underwent SLNB. The median age was 58.1 years [49.6; 65.3]. Stage IA disease was diagnosed in 80.4% of patients and stage IIA in 19.6%; 84.8% had invasive ductal carcinoma, 73.0% had luminal A subtype, and 89.7% had moderately differentiated tumors. Multicentric growth was present in 7.8% of cases.
Results. The median follow-up was 76.4 months [64.6; 81.4]. Disease progression was detected in 4.4% of patients (n = 9): 5.9% in Group I and 3.9% in Group II. Local recurrence occurred in 0.7% of cases (only in Group II). Regional recurrence was observed in 1.5% of cases (in both groups). Distant metastases developed in 2.5% of patients (n = 5). The five-year overall survival rate was 100% in both groups; progression-free survival rates were 95.2 ± 3.4% in Group I and 98.0 ± 1.1% in Group II. The median survival was not reached.
Conclusion. Patients with cT1-2cN0 breast cancer may be considered candidates for omission of SLNB without compromising oncological outcomes, provided they receive comprehensive treatment and follow-up.
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