EP283 - Sentinel Lymph Node Biopsy Should Not Be Withheld In Patients With Early Breast Cancer Over 70 Years Of Age
Bibliographic record
Abstract
Abstract Introduction North American Choosing Wisely guidelines currently state patients with hormone receptor (HR) positive, HER2 negative early breast cancer over 70 [EBC] should avoid sentinel lymph node biopsy (SLNB). Methods Data was collected over a 2-year period in patients over 70 years with EBC. Results 22 patients, mean age 77.0, (70-89). Dual tracer was attempted in all cases. There was no significant difference in age, tumour size or BMI between dual lymphatic mapping vs single tracer success (unpaired t test, p = 0.80, 0.61 and 0.31). SLNB failed in one patient (EBC, breast cancer surgery with axillary dissection 15 years before). SNLB success rate 97.5% Positive nodes at SLNB were found in 5 EBC patients (22.7%), mean age 79.2 years (74-86), mean tumour size 27.8mm (11-78mm); mean number of sentinel nodes removed was 5.8 (range 4-9), mean number of positive nodes 1.8 (range 1-4). In the 5 patients with lymph node disease, 3 had metastasis, two micrometastasis), 4 nodes were retrieved at SLNB in all 3 cases, positive node range 1-4. All 5 patients with positive nodes were HR positive, HER negative. All had adjuvant treatment, 4 out of the 5 had tumours less than 1.5cm in size. Mean survival after surgery 63.5 months (40-87 months), mean follow up 71.4 months (50-90 months). Conclusion Our study indicates contrary to current Choosing Wisely guidelines, there is benefit for SLNB in over 70s, even with small HR positive, tumours, usually thought to be at low risk of metastasis. We found SLNB safe and effective. To accurately identify positive nodes, up to 4 sentinel nodes should be retrieved.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".