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CME

GP6. Evaluating the Safety of Sentinel Node Biopsy Omission in Early-Stage Invasive Lobular Carcinoma

Thursday, March 5, 2026
11:07 AM - 11:14 AM MST
Location: 106A-C

    Primary Presenter(s)

  • Lorenzo Scardina, MD (he/him/his)

    Consultant Breast Surgeon
    Breast Unit, Department of Science and Health of Women, Children and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
    Roma, Lazio, Italy

AUTHORS: Lorenzo Scardina*, Sabatino D’Archi, Cristina Accetta, Beatrice Carnassale, Alba Di Leone, Flavia De Lauretis, Antonio Franco, Federica Gagliardi, Stefano Magno, Francesca Moschella, Maria Natale, Alejandro Martin Sanchez, Marta Silenzi, Ersilia Biondi, Enrico Di Guglielmo, Elisabetta Gambaro, Annasilvia Di Pumpo, Eleonora Petrazzuolo, Chiara Rianna, Gianluca Franceschini. 

 Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS. 

 

Introduction:  Recent trials suggest omission of sentinel lymph node biopsy (SLNB) in selected early-stage breast cancer patients. However, invasive lobular carcinoma (ILC) is underrepresented and retrospective data indicate higher rates of nodal metastases raising concern for axillary understaging. This study aims to evaluate the prevalence and predictors of nodal metastases in early-stage, clinically node-negative ILC and assess the oncologic safety of SLNB omission. 



Methods:  We retrospectively analyzed 625 patients with ER-positive/HER2-negative, T1–T2, clinically node-negative ILC who underwent breast-conserving surgery at our institution between 2004–2024. Exclusion criteria included neoadjuvant therapy, tumor >5 cm, metastatic disease at diagnosis or prior breast cancer. 

 

Results:  Among 625 patients, 471 (75.4%) were pN0 and 154 (24.6%) had nodal metastases (pN1mi–pN3). Histologic subtype significantly correlated with nodal involvement (p = 0.0035): classic ILC predominated in pN0 cases (66.1%), while pleomorphic and mixed variants were more common in node-positive patients. Tumor size was strongly associated with nodal burden (p < 0.0001). Menopausal status was not predictive (p = 0.572). 



Conclusions:  Nearly 25% of early-stage, clinically node-negative ILC harbor occult nodal metastases. Classic ILC and smaller tumors correlate with negative nodal status whereas pleomorphic/mixed histology and larger tumors predict advanced nodal involvement. These findings indicate that omission of SLNB in ILC may carry a risk of axillary understaging and consequent therapeutic implications. Pending evidence from prospective studies specifically designed for lobular histology, SLNB should continue to be considered an essential component of axillary evaluation in this subgroup.