《明智选择》不鼓励对≥70岁女性的早期HR/HER2-乳腺癌进行常规前哨淋巴结切除术(SLNB)，但对于≥70岁的DCIS女性接受乳房切除术是否可以常规省略SLNB尚不清楚。本研究旨在评估该人群的腋窝手术率和淋巴结阳性率 (pN )，以确定腋窝手术对治疗决策的影响。从国家癌症数据库（2012-2020 年）中确定了≥70 岁的 DCIS 女性接受乳房切除术。评估升级为浸润性癌（≥pT1）或 pN 的比率。对 ER 患者进行了亚组分析。按淋巴结状态分层后，对 ≥pT1 患者的辅助治疗进行评估。在 9,030 名患者中，1,896 名 (21%) 升级至 ≥pT1。 86% 的患者进行了腋窝手术，主要是前哨淋巴结切除术（SLNB，65%）。事后应用“明智选择”标准表明，整个队列中 93% 的患者和 97% 的 ER DCIS 患者可以避免腋窝手术。在未升期的患者中，淋巴结阳性率为 0.3%，在升期至 ≥pT1 的患者中，淋巴结阳性率为 12%，其中 <2% 患有 pN2-3 疾病，无论受体亚型如何。淋巴结阳性患者的辅助治疗使用率较高，但没有建议分别对 71% 和 66% 的 pN 患者进行辅助化疗或放疗。对于大多数 ≥70 岁因 ER DCIS 接受乳房切除术的患者，可以省略腋窝手术，与对于浸润性癌症的建议，对于患有 ER 疾病的患者可以考虑省略。未来的指南结合术前影像学（如 SOUND 试验）可能有助于识别从腋窝手术中受益的患者。© 2024。外科肿瘤学会。

Routine sentinel lymphadenectomy (SLNB) for early-stage HR+/HER2- breast cancer in women ≥70 is discouraged by Choosing Wisely, but whether SLNB can be routinely omitted in women ≥70 with DCIS undergoing mastectomy is unclear. This study aims to evaluate rates of axillary surgery and nodal positivity (pN+) in this population to determine the impact of axillary surgery on treatment decisions.Females ≥70 with DCIS undergoing mastectomy were identified from the National Cancer Database (2012-2020). The rate of upstaging to invasive cancer (≥pT1) or pN+ was assessed. Subset analyses were conducted for ER+ patients. Adjuvant therapies were evaluated among ≥pT1 patients after stratifying by nodal status.Of 9,030 patients, 1,896 (21%) upstaged to ≥pT1. Axillary surgery was performed in 86% of patients, predominantly sentinel lymphadenectomy (SLNB, 65%). Post hoc application of Choosing Wisely criteria demonstrated that 93% of the entire cohort and 97% of ER+ DCIS patients could have avoided axillary surgery. Nodal positivity was 0.3% among those who didn't upstage, and 12% among those upstaging to ≥pT1, with <2% having pN2-3 disease, irrespective of receptor subtype. Node-positive patients had higher adjuvant therapy usage, but there was no recommendation for adjuvant chemotherapy or radiation for 71% and 66% of pN+ patients, respectively.Axillary surgery can be omitted for most patients ≥70 undergoing mastectomy for ER+ DCIS, aligning with recommendations for invasive cancer, and omission can be considered in those with ER- disease. Future guidelines incorporating preoperative imaging, as in the SOUND trial, may aid in identifying patients benefiting from axillary surgery.© 2024. Society of Surgical Oncology.