Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: A systematic review

Deurzen, Carolien H.M. van; Vriens, B.E.P.J.; Tjan‐Heijnen, Vivianne C. G.; Wall, Elsken van der; Albregts, M.; Hilligersberg, Richard van; Monninkhof, Evelyn M.; Diest, Paul J. van

doi:10.1016/j.ejca.2009.08.001

Cited by 185 publications

(103 citation statements)

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“…We selected 1993 as the starting point because it was the year of the first publication on SLNB. 12 The following search terms were used: "prophylactic mastectomy," "reduction mastectomy," "contralateral mastectomy" and "bilateral mastectomy" combined with "lymph node," "sentinel node," "axillary surgery" and "axillary dissection." We also reviewed the references in identified articles for possible inclusions.…”

Section: Literature Search Strategymentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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Background: Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the time of prophylactic mastectomy is controversial, and we performed a meta-analysis of the reported data to assess that benefit. Methods:We searched MEDLINE, EMBASE and the Cochrane Library databases from January 1993 to December 2009 for studies on patients who underwent SLNB at the time of prophylactic mastectomy. Two reviewers independently evaluated all the identified papers, and only retrospective studies were included. We used a mixedeffect model to combine data. Results:We included 6 studies in this review, comprising a total study population of 1251 patients who underwent 1343 prophylactic mastectomies. Of these 1343 pooled prophylactic mastectomies, the rate of occult invasive cancer (21 cases) was 1.7% (95% confidence interval [CI] 1.1%-2.5%), and the rate of positive SLNs (23 cases) was 1.9% (95% CI 1.2%-2.6%). In all, 36 cases (2.8%, 95% CI 2.0%-3.8%) led to a significant change in surgical management as a result of SLNB at the time of prophylactic mastectomy. In 17 cases, patients with negative SLNs were found to have invasive cancer at the time of prophylactic mastectomy and avoided axillary lymph node dissection (ALND). In 19 cases, patients with positive SLNBs were found not to have invasive cancer at the time of prophylactic mastectomy and needed a subsequent ALND. Of the 23 cases with positive SLNs, about half the patients had locally advanced disease in the contralateral breast. Conclusion:Sentinel lymph node biopsy is not suitable for all patients undergoing prophylactic mastectomy, but it may be suitable for patients with contralateral, locally advanced breast cancer.Contexte : La mastectomie prophylactique vise à réduire le risque de cancer du sein chez les femmes à risque élevé. L'avantage de la biopsie du ganglion lymphatique sentinelle (BGLS) au moment de la mastectomie prophylactique suscite la controverse et nous avons procédé à une méta-analyse des données qui ont fait l'objet de rapports afin d'évaluer l'avantage en question. Méthodes :Nous avons cherché dans les bases de données MEDLINE, EMBASE et la Bibliothèque Cochrane, de janvier 1993 à décembre 2009, des études portant sur des patientes qui ont subi une BGLS au moment de la mastectomie prophylactique. Deux examinateurs ont évalué indépendamment toutes les études repérées et nous avons inclus seulement les études rétrospectives. Nous avons utilisé un modèle à effets mixtes pour combiner les données.Résultats : Nous avons inclus dans cette analyse 6 études regroupant une population totale de 1251 patientes qui ont subi 1343 mastectomies prophylactiques. Parmi ces 1343 mastectomies prophylactiques regroupées, le taux de cancer envahissant occulte (21 cas) s'est établi à 1,7 % (intervalle de confiance [IC] à 95 %, 1,1 %-2,5 %) et le taux de GLS positifs (23 cas) a atteint 1,9 % (IC à 95 %, 1,2 %-2,6 %). Au total, les constatations dans 36 cas (2,8 %, IC ...

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Section: Literature Search Strategymentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Zhou

Dai

et al. 2011

Can J Surg

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“…In that context, one should recognize that the results represent a new baseline, one different from the baseline before neoadjuvant chemotherapy, even if a pretherapy baseline was not obtained. Multiple metaanalyses suggest that SLN identification can be more than 90% and false-negative rates less than 12% in SLNBs after neoadjuvant chemotherapy (15,(30)(31)(32). Each neoadjuvant chemotherapy patient must be evaluated individually as to whether an SLN procedure is appropriate and, if so, when it should be performed.…”

Section: Cancer Indications Breast Cancermentioning

confidence: 99%

Lymphoscintigraphy and Sentinel Nodes

2015

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) generic fundamentals of lymphoscintigraphy procedures of sentinel lymph node biopsy (SLNB) protocols; (2) specific injection and imaging components of SLNB protocols used in the management of patients with breast cancer, melanoma, and head and neck malignancies; and (3) specific indications of breast cancer, melanoma, and head and neck malignancies that suggest inclusion of a SLNB in the management of a patient.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through June 2018.It has been validated that sentinel lymph node biopsy (SLNB) shows whether a patient's breast cancer or melanoma has spread to regional lymph nodes. As a result, management of patients with these cancers has been revolutionized. SLNB has replaced axillary lymph node dissection (ALND) as the staging modality of choice for early breast cancer and has replaced complete lymph node dissection as the staging modality of choice for melanoma in patients whose SLNBs indicate no metastases. Recently concluded multicenter, randomized trials for breast cancer with 5-to 10-y outcome data have shown no significant differences in disease-free survival rates or overall survival rates between SLNB and ALND groups but have shown significantly lower morbidity with SLNB than with ALND. The lowest false-negative rates (5.5%-6.7%) were seen in studies that used preoperative lymphoscintigraphy and dual mapping during surgery. To assess the survival impact of SLNB in melanoma, the Multicenter Selective Lymphadenectomy Trial I was performed. Melanoma-specific survival rates were not different between subjects randomized to SLNB with lymphadenectomy for nodal metastasis on biopsy and subjects randomized to observation with lymphadenectomy for nodal relapse. However, the 10-y disease-free survival rates were better for the SLNB group than for the observation group, specifically among patients with intermediate-thickness melanomas or thick melanomas.

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“…Most authors have taken the position to do it after NAC [914] , and results from metaanalysis and prospective studies have reported a success rate of SLN identification after NAC of 90% and rates of false negative around 10.5% [9,10] . In patients with clinically negative axilla, rates of success and false negative rates are similar to those in the adjuvant setting, so SLN after NAC in previous negative axilla has been incorporated in the staging of the axilla [15] . Recently, in a populationbased study of SLN before (980 patients) or after NAC (203 patients) in clinically node negative patients of the Netherlands Cancer Registry, the SNL identification rate was higher in the SLN pre NAC group vs after NAC (98% vs 95%; P = 0.032).…”

Section: Sentinel Lymph Node After Neoadjuvant Treatmentmentioning

confidence: 92%

“…Rates of positivity of non sentinel nodes with a micrometastasis in the SLN in patients with NAC have been reported to be between 12% to 50% [1315] and the SLN is the only positive node in around 50% of cases, rates lower than the adjuvant setting [15] . It is likely that micrometastasis in the SLN in patients after NAC has a different meaning than micrometastasis in the SLN in adjuvant therapy.…”

Section: Minimal Sln Involvement In the Sln (Isolated Tumor Cells)mentioning

confidence: 99%

Sentinel lymph node metastasis after neoadjuvant treatment in breast cancer: Any size matters?

Rubio¹

2015

WJCO

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One of the advantages of neoadjuvant chemotherapy (NAC) treatments is its ability to convert patients who need a mastectomy in breast conservative surgery. NAC has also increased the conversion of node positive patients into node negative in around 40% allowing the use of sentinel node biopsy (SLN) in this setting. Timing of SLN biopsy after NAC has been a subject of debate. In patients with clinically node negative before NAC, rates of success and false negative rates of SLN after NAC are similar to those in the adjuvant setting, so SLN after NAC in previous negative axilla has been incorporated in the staging of the axilla. More controversial is its use in patients with positive axillary nodes before NAC who convert to node negative after NAC. Several randomized studies have reported the identification rates and the false negative rates of the SLN after NAC, concordant in the importance of surgical technique. As there is an agreement in the abandon of the immunohistochemistry (IHC) for SLN in the adjuvant setting as SLN IHC detected metastasis appear to have no impact on overall survival, in patients with SLN after NAC the inclusion of isolated tumor cell (ITC) as positive nodes lowers the false negative rates of the technique, suggesting the importance of assessing the SLN by IHC after NAC and considering it as residual disease. Longer follow up is needed to determine the prognostic implications of ITC in the SLN after NAC.

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Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: A systematic review

Cited by 185 publications

References 56 publications

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Meta-analysis of sentinel lymph node biopsy at the time of prophylactic mastectomy of the breast

Lymphoscintigraphy and Sentinel Nodes

Sentinel lymph node metastasis after neoadjuvant treatment in breast cancer: Any size matters?

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