PPS40. Does axillary ultrasound decrease nodal recurrence in women age 70 years and over treated without SLNB?

Friday, March 6, 2026

3:40 PM - 4:10 PM MST

Location: HUB Poster Park - West Hall 1-3

Poster Presenter(s)

Alison P. Woods, MD, MHS

Breast Surgical Oncology Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Co-Author(s)

RK

Risa Kiernan, DO

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Jacquelyn Dillon, MD (she/her/hers)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
NY, New York, United States
PG

Paula Garcia, MHA

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
VS

Varadan Sevilimedu, MBBS, DrPH

Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Primary Author(s)

Monica Morrow, MD (she/her/hers)

Chief, Breast Service, Department of Surgery; Anne Burnett Windfohr Chair of Clinical Oncology; Vice President, Women in Science and Medicine, MSKCC; Professor of Surgery, Weill Cornell Medical College of Cornell University
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Introduction: Eligibility criteria for the SOUND and INSEMA trials of sentinel lymph node biopsy (SLNB) omission included a normal axillary ultrasound (US). However, the clinical benefit of US among cN0 patients is unclear. We investigated whether US is associated with differences in nodal or invasive disease recurrence among breast cancer patients age ≥ 70 years who did not have SLNB.

Methods: Single-institution retrospective cohort study of women age ≥ 70 years with cT1-2N0, HR+/HER2- breast cancer who underwent definitive surgery without SLNB from 2016-2022. US was not required, but was performed in some patients, usually prior to coming to our center. Nodal and invasive disease recurrence were evaluated using Cox proportional hazard models.

Results: 392 patients met inclusion criteria, with 389 (99.2%) undergoing partial mastectomy. Median patient age was 77 years (IQR, 73-81) and 90.8% of tumors were cT1. The most common histologies were invasive ductal carcinoma (n = 290, 74.0%) and lobular carcinoma (n = 53, 13.5%) (Table). US was performed in 205 (52.3%) patients; 194 (94.6%) were normal. In the 11 patients with indeterminate or abnormal findings, 4 underwent FNA (0 malignant), 3 had non-worrisome repeat imaging, and 4 had no further workup based on clinical discretion. 94 (24.0%) patients had postoperative radiation therapy and 312 (79.6%) initiated adjuvant endocrine therapy. At a median follow-up of 4.3 years there were only 3 (0.8%) nodal recurrences; 1 isolated nodal failure, 1 simultaneous with ipsilateral breast recurrence, and 1 simultaneous local, nodal, and distant recurrence. 2 nodal recurrences were in the no-US group and 1 in the US group. Any invasive breast cancer (recurrence or second primary) occurred in 15 (3.8%) patients. On unadjusted Cox analysis, patients with axillary US had no difference in nodal recurrence compared to those without US (HR 0.47, 95% CI 0.04-5.20) and no difference in any invasive recurrence (HR 0.62, 95%CI 0.22-1.73). Age, clinical T stage, and receipt of postoperative radiation were not significantly associated with nodal or any invasive recurrence, and no adjusted analysis was performed.

Conclusions: Nodal recurrence was rare among our cohort of cT1-2 N0 HR+/HER2- breast cancer patients age ≥70 years in the absence of SLNB, and was not associated with the use of preoperative US, in spite of the fact that only a quarter of patients received RT. Our results suggest that the necessity of US in younger postmenopausal cN0 patients omitting SLNB is worthy of study.

Learning Objectives:

Participants should understand that nodal failure in women ≥70 with early-stage HR+ tumors is rare.
Participants should be able to critically evaluate the practice of routine preoperative axillary ultrasound in patients age 70 or over with early-stage HR+ tumors.