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Using National Cancer Database data (2018–2020), the study estimates how absence of lymph node pathology would change adjuvant chemotherapy, CDK4/6 inhibitor therapy, and regional nodal irradiation decisions for cT1N0 hormone receptor–positive disease. Outcomes quantify affected proportions, emphasizing OncotypeDX reliance and decision impact by menopausal status.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/implications-of-omitting-sentinel-lymph-node-biopsy-on-adjuvant-decision-making-for-patients-with-small-breast-cancers/371517/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/implications-of-omitting-sentinel-lymph-node-biopsy-on-adjuvant-decision-making-for-patients-with-small-breast-cancers/371517.png","ImageObject",300,407,{"name":92,"@type":93},"Alex Sinclair","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical problem does this study address about SLNB omission?","Question",{"text":113,"@type":114},"The study examines how omitting sentinel lymph node biopsy may alter guideline-based adjuvant treatment decisions when lymph node pathology is unavailable.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which patient and treatment decision factors were assessed?",{"text":118,"@type":114},"It estimates changes in adjuvant chemotherapy, CDK4/6 inhibitor therapy, and regional nodal irradiation decisions for cT1N0 hormone receptor–positive small breast cancers.",{"name":120,"@type":111,"acceptedAnswer":121},"How were impacted proportions estimated when SLNB was omitted?",{"text":122,"@type":114},"Because OncotypeDX testing is essential when SLNB is omitted, inverse probability weighting was used to approximate outcomes as if all patients had undergone OncotypeDX testing.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},371517,1790464710,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},1099523882182,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","DOI: 10. 1002/cncr.35910  \nORIGINAL ARTICLE  \nImplications of omitting sentinel lymph node biopsy on adjuvant decision making for patients with small breast cancers  \nKerollos Nashat Wanis MD, PhD1,2 | Melissa P. Mitchell MD, PhD3 |  \nSharon H. Giordano MD, MPH2,4 | Jennifer Keating Litton MD, MHCM4  |  \nSimona F. Shaitelman MD, EdM3 | Nina Tamirisa MD 1  | Isabelle Bedrosian MD 1  | Wenli Dong MS5 | Yu Shen PhD5 | Kelly K. Hunt MD 1 | Puneet Singh MD, MS1 | Susie X. Sun MD, MS1  | Abigail S. Caudle MD 1  | Henry M. Kuerer MD, PhD1 | Funda Meric-Bernstam MD 1  | Rosa F. Hwang MD1 | Taiwo Adesoye MD, MPH1   \n1Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA  \n2Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA  \n3Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA  \n4Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA  \n5Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA  \nCorrespondence  \nTaiwo Adesoye, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1434, Houston, TX 77030, USA.  \nEmail: [tadesoye@mdanderson.org](tadesoye@mdanderson.org)  \nFunding information  \nUniversity of Texas MD Anderson Cancer Center, Grant/Award Number: CA16672  \nAbstract  \nBackground: Selective omission of sentinel lymph node biopsy (SLNB) in patients with early breast cancer limits surgical morbidity. Adoption of this strategy relies on multidisciplinary consensus. Understanding how SLNB omission influences guideline-based adjuvant treatment decisions, and the proportion of patients impacted, can help guide decision-making.  \nPatients and methods: Data from the National Cancer Database (2018–2020) was used to estimate the proportions of patients with cT1N0 hormone receptor– positive breast cancer for whom adjuvant chemotherapy, CDK4/6 inhibitor therapy, and regional nodal irradiation decisions would be impacted by the absence of lymph node pathology if national treatment guidelines were followed. Because OncotypeDX score is essential to adjuvant decision-making when SLNB is omitted, inverse probability weighting was used to estimate the proportions of interest had all individuals undergone OncotypeDX testing.  \nResults: There were 119,312 included patients, with an average age of 63 years, 96,454 (80.8%) having invasive ductal histology, and 52,222 (43.8%) having cT1c tumors. The number of patients with SLNB positivity was 13,211 (11. 1%). Among postmenopausal women, 7. 9%(95% CI, 7.7–8. 1) would have had at least one adjuvant decision impacted by the absence of lymph node pathology. For premenopausal women, the affected proportion was 13. 7%(95% CI, 13.0–14. 7). When ribociclib decision-making was not considered, these estimates were 2. 5% for postmenopausal women and 12. 6% for premenopausal women.  \nThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.  \n© 2025 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.  \nCancer. 2025;e35910.  \n[https://doi.org/10.1002/cncr.35910](https://doi.org/10.1002/cncr.35910)  \nwi[leyonlinelibrary.com/journal/cncr](leyonlinelibrary.com/journal/cncr)  \n1 of 9  \nConclusions: SLNB omission has a small – but not negligible – influence on adjuvant decision making in postmenopausal women, whereas a larger proportion of premenopausal women would be impacted. The reported estimates may inform multidisciplinary decision-making related to SLNB omission.  \nKEYWORDS  \nadjuvant therapy, breast cancer, guideline-c","cbCairXYVPXakfOV","https://ap.wps.com/l/cbCairXYVPXakfOV","pdf",714469,"English","# Abstract\n## Background\n## Patients and methods\n## Results\n## Conclusions\n# Introduction\n## Evolution of axillary management\n## Evidence supporting SLNB omission\n## Nodal pathology and adjuvant decisions","[{\"question\":\"What clinical problem does this study address about SLNB omission?\",\"answer\":\"The study examines how omitting sentinel lymph node biopsy may alter guideline-based adjuvant treatment decisions when lymph node pathology is unavailable.\"},{\"question\":\"Which patient and treatment decision factors were assessed?\",\"answer\":\"It estimates changes in adjuvant chemotherapy, CDK4/6 inhibitor therapy, and regional nodal irradiation decisions for cT1N0 hormone receptor–positive small breast cancers.\"},{\"question\":\"How were impacted proportions estimated when SLNB was omitted?\",\"answer\":\"Because OncotypeDX testing is essential when SLNB is omitted, inverse probability weighting was used to approximate outcomes as if all patients had undergone OncotypeDX testing.\"}]","Implications of omitting sentinel lymph node biopsy on adjuvant decision making for patients with small breast cancers | PDF",1790192252,23]