The use of sentinel lymph node biopsy (SLNB) in inflammatory breast cancer (IBC) is on the rise in the United States, even though it is not recommended in current guidelines, according to research published in JAMA Network Open.

The researchers noted that the recommended treatment for IBC is trimodal therapy — neoadjuvant chemotherapy, total mastectomy with axillary lymph node dissection (ALND), and postmastectomy radiation therapy. Although SLNB has proven useful in other breast cancer settings, it is not recommended in IBC.  

For this study, researchers evaluated the frequency and trends of SLNB use among patients diagnosed with IBC. Data were obtained from the US National Cancer Database, and all patients were diagnosed with breast cancer between 2012 and 2017.

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Of the 1.4 million patients identified, 1096 patients met the study criteria and were included in the analysis. All patients were 18 years or older, and the mean patient age was 56.1 years.

Overall, 17% of patients (186/1096) received any SLNB, and 64% of those patients (119/186) did not complete ALND. The use of SLNB increased significantly over the period studied, from 11% in 2012 to 22% in 2017 (P =.004).

In a multivariate analysis, the use of SLNB was significantly associated with:

  • A later year of diagnosis (odds ratio [OR] for 2017 vs 2012, 2.26; 95% CI, 1.26-4.20)
  • Clinical nodal status (OR for clinical nodal stage 3 vs 0, 0.39; 95% CI, 0.22-0.67)
  • Undergoing reconstructive surgery (OR, 1.80; 95% CI, 1.09-2.96).

“The use of SLNB in patients with IBC is not evidence-based, not supported by current guidelines, and may represent an unsafe de-escalation of care in highly aggressive cancer,” the researchers wrote. “In the absence of high-quality randomized data, SLNB should not be used for patients with IBC.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Sosa A, Lei X, Woodward WA, et al. Trends in sentinel lymph node biopsies in patients with inflammatory breast cancer in the US. JAMA Netw Open. 2022;5(2):e2148021. doi:10.1001/jamanetworkopen.2021.48021

Topics:

Breast Cancer