Clinical surgery Is breast cancer sentinel lymph node mapping valuable for patients in their seventies and beyond? Lisa E. McMahon, M.D., Richard J. Gray, M.D.*, Barbara A. Pockaj, M.D. Section of Surgical Oncology, Department of Surgery, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA Manuscript received August 24, 2004; revised manuscript March 8, 2005 Abstract Background: Axillary lymph node dissection (ALND) is performed less commonly for the axillary staging of elderly patients because it is felt to uncommonly alter therapy. Sentinel lymph node (SLN) dissection can accomplish axillary staging with less morbidity, but it is unclear if it alters subsequent therapy. Methods: Review of a prospectively collected breast cancer SLN mapping database. Medical records were reviewed to supplement the database. Results: Among 730 breast cancer SLN mapping patients, 261 (35.8%) were 70 years of age (range 70 to 95). The overall SLN identification rate was 98.8% among those 70 and 97.1% for those 70 (P = .11) and 100% and 99.4%, respectively (P = .25), among the most recent 500 patients. SLN metastases were detected by hematoxalin and eosin staining (H&E) in 24.2% of those 70 and 13.4% of those 70 (P  .01) and by immunohistochemistry staining (IHC) only in 4.6% and 5.0% of patients, respectively. No elderly patients with histologically negative SLNs underwent ALND, but 88.9% of patients with H&E metastases and 84.6% with IHC metastases underwent ALND. Of the H&E-positive women, 88% underwent adjuvant systemic therapy versus 55% of H&E-negative women (P  .01). Hormonal therapy was administered to 86.9% of SLN-positive women and 54.3% of SLN-negative women (P  .01) and cytotoxic chemotherapy was administered to 24% of SLN-positive patients versus 2.8% of SLN-negative patients (P  .01). SLN status was associated with significantly different rates of systemic therapy for patients with tumors 1 cm and 1 to 2 cm, but not with tumors 2 cm. Mean follow-up was 15.4 months. No patient experienced local or regional recurrence. Distant metastases occurred in 8.2% of patients with SLN metastases and in no patients with negative SLNs (P  .01). Conclusions: The results of SLN mapping and biopsy in elderly patients significantly influences subsequent therapy decisions, including ALND, hormonal therapy, and cytotoxic chemotherapy. SLN biopsy should be recommended to elderly breast cancer patients. © 2005 Excerpta Medica Inc. All rights reserved. Keywords: Breast cancer; Elderly; Sentinel lymph node biopsy; Axillary lymph node dissection Cancer incidence and death rates increase with age. Approx- imately half of all breast cancers occur in patients older than 65 years of age [1] and the median age of breast cancer diagnosis is 63 years [2]. As the population ages, both the prevalence and incidence of breast cancer may increase by as much as 30% [3]. The initial treatment of most breast cancers is surgical. Early-stage cancer can be treated with breast conservation therapy or mastectomy. Recent reports of randomized trials with 20-year follow-ups observed no difference in overall survival between the 2 surgical therapies [4,5]. Surgical therapy of breast cancer is usually very well tolerated, with a 30-day operative mortality of less than 1% for patients over 65 years of age [6]. Axillary lymph node dissection (ALND) has been an important component of breast cancer surgery that is used to stage the axilla and help guide subsequent therapy. Unfortunately, surgical staging of the axilla is underused in the elderly. Increasing age, indepen- dent of patient health, preferences, and primary tumor char- acteristics, has been shown to be strongly associated with decreasing odds of undergoing ALND [7]. Several reports have suggested that the treatment plan of elderly patients is not altered by routine ALND [8 –10] and so it is suggested that the morbidity of this procedure is not offset by signif- icant benefits in this age group. Sentinel lymph node (SLN) mapping and biopsy has * Corresponding author. Tel.: +1-480-342-6091; fax: +1-480-301- 8414. E-mail address: Gray.Richard@mayo.edu The American Journal of Surgery 190 (2005) 366 –370 0002-9610/05/$ – see front matter © 2005 Excerpta Medica Inc. All rights reserved. doi:10.1016/j.amjsurg.2005.03.028