The diagnostic performance of sentinel lymph node biopsy in pathologically confirmed node positive breast cancer patients after neoadjuvant systemic therapy: A systematic review and meta-analysis

T.J.A. van Nijnatten, R.J. Schipper, M.B.I. Lobbes, P.J. Nelemans, R.G.H. Beets-Tan

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

Purpose: To provide a systematic review and meta-analysis of studies investigating sentinel lymph node biopsy after neoadjuvant systemic therapy in pathologically confirmed node positive breast cancer patients.

Methods: Pubmed and Embase databases were searched until June 19th, 2015. All abstracts were read and data extraction was performed by two independent readers. A random-effects model was used to pool the proportion for identification rate, false-negative rate (FNR) and axillary pCR with 95% confidence intervals. Subgroup analyses affirmed potential confounders for identification rate and FNR.

Results: A total of 997 abstracts were identified and eventually eight studies were included. Pooled estimates were 92.3% (90.8-93.7%) for identification rate, 15.1% (12.7-17.6%) for FNR and 36.8% (34.2-39.5%) for axillary pCR. After subgroup analysis, FNR is significantly worse if one sentinel node was removed compared to two or more sentinel nodes (23.9% versus 10.4%, p = 0.026) and if studies contained clinically nodal stage 1-3, compared to studies with clinically nodal stage 1-2 patients (21.4 versus 13.1%, p = 0.049). Other factors, including single tracer mapping and the definition of axillary pCR, were not significantly different.

Conclusion: Based on current evidence it seems not justified to omit further axillary treatment in every clinically node positive breast cancer patients with a negative sentinel lymph node biopsy after neoadjuvant systemic therapy. (C) 2015 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)1278-1287
Number of pages10
JournalEuropean Journal of Surgical Oncology
Volume41
Issue number10
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Breast cancer
  • Sentinel lymph node biopsy
  • Clinically node positive patients
  • Neoadjuvant systemic therapy
  • ACOSOG Z1071 ALLIANCE
  • PREOPERATIVE CHEMOTHERAPY
  • CLINICAL-TRIAL
  • PHYSICAL-EXAMINATION
  • AXILLARY DISSECTION
  • F-18-FDG PET/CT
  • FEASIBILITY
  • METASTASES
  • ULTRASOUND
  • ACCURACY

Cite this