For middle-aged women with a certain kind of breast cancer, sentinel lymph node biopsy surgery may do more harm than good, according to a new study led by University of Pittsburgh and UPMC Hillman Cancer Center researchers. The team used a novel artificial intelligence pipeline developed by Realyze Intelligence, a UPMC Enterprises portfolio company, to analyze electronic health records.
The findings, published in JCO Clinical Cancer Informatics, suggest that clinical guidelines for de-escalating surgery in women aged over 70 years with early-stage estrogen receptor-positive (ER+) breast cancer may be safely extended to postmenopausal patients 55 or older.
“This research informs the overall goal of moving away from a one-size-fits-all approach for treating breast cancer,” said Neil Carleton, lead author and graduate student in Pitt’s Medical Scientist Training Program. “Instead, our focus is tailoring care so that treatment is at the right level for each patient, which includes doing less surgery when it’s unlikely to have a benefit.”
Sentinel lymph node biopsy, which involves surgically removing one or more lymph nodes that drain from a patient’s primary tumor, allows oncologists to detect whether the cancer has spread. This procedure is usually standard-of-care for patients with breast cancer, but there are risks, including lymphedema, or buildup of lymphatic fluid, which causes swelling, discomfort and mobility issues.
“Even though there is a relatively low risk of lymphedema after sentinel lymph node biopsy, this condition can have devastating effects on a person’s quality of life,” said senior author Emilia Diego, associate professor of surgery, vice chair for diversity and inclusion, and section chief of breast surgery in the breast surgical oncology division, Department of Surgery.
“This study points to the low likelihood of additional information from a sentinel node biopsy, suggesting it may not be necessary for care in every breast cancer case,” said Diego, who is also codirector of the Breast Cancer Program at Hillman Cancer Center and at UPMC Magee-Womens Hospital.
“In older patients with small tumors, rates of lymph node positivity are very low, suggesting that sentinel lymph node biopsy does not provide additional information to guide therapy,” Carleton explained. “Given the risk of lymphedema and low nodal involvement, the potential harms of this procedure may outweigh the benefits.”