Management of the Axilla in Older Patients with Breast Cancer: Reassessing the Role of Sentinel Lymph Node Biopsy

Background: Sentinel lymph node biopsy (SLNB) has traditionally been used to stage the axilla in early-stage breast cancer. However, its utility in women over 70 with hormone receptor-positive tumors and negative axillary imaging is increasingly questioned due to limited therapeutic benefit and potential complications. Objectives. To assess the feasibility of omitting SLNB in women aged 70 and older with clinically node-negative, luminal-type breast cancer. Methods: A retrospective analysis was conducted on women aged 70 and above with histologically confirmed invasive breast cancer, negative axillary imaging, and surgery between January 2021 and December 2024. Eligible patients were selected based on normal axillary ultrasound findings. All underwent SLNB. We examined demographics, clinical characteristics, surgical outcomes, and oncological variables such as recurrence and mortality. Results: A total of 149 women underwent surgery, with a mean age of 77.2 (5.24) years. SLNB was positive in 23.5% of cases, but only 6.7% required axillary dissection. Sensitivity and specificity of SLNB declined notably after age 76. No axillary or breast recurrences were reported. Most patients (89.9%) received hormonal therapy, while 11.4% had chemotherapy and 17.5% axillary radiotherapy. Outpatient management was feasible in 87.9% of cases, and no clinically significant lymphedema was observed. Conclusions: Omitting SLNB in women ≥70 years with luminal breast cancer and negative axillary imaging appears safe and does not compromise oncological outcomes. This strategy minimizes surgical risks and enhances quality of life, supporting a more tailored and less invasive approach to axillary management in older patients.