Feasibility and Accuracy of Sentinel Lymph Node Biopsy in Clinically Node Negative Patients after Neoadjuvant Chemotherapy for Breast Cancer – A Systematic Review and Metaanalysis.

Abstract

BackgroundThe sentinel lymph node biopsy (SLNB) has become an accepted alternative to the axillary lymph node dissection (ALND) for pathologic evaluation of the axillary lymph node status in patients with early breast cancer and a clinically negative axilla. Patients with a negative sentinel lymph node are spared the ALND and its associated morbidities.Currently, there is insufficient evidence to recommend the use of SLNB in patients who have received neoadjuvant chemotherapy (NAC), and treatment of the axilla after neoadjuvant chemotherapy is an ALND.The use of neoadjuvant chemotherapy is increasing, and NAC has been shown to downstage both the primary tumour and axillary lymph nodes. Potentially, an additional proportion of patients who are node negative after NAC may be spared a full ALND and its attendant morbidities.AimsTo determine the feasibility and accuracy of SLNB in patients who have a clinically negative axilla after neoadjuvant chemotherapy for breast cancer.MethodsA systematic review of the English literature of SLNB in patients who have had neoadjuvant chemotherapy (NAC) was conducted and meta analyses performed. Studies selected had an identifiable group of patients with breast cancer who received neoadjuvant chemotherapy and were clinically node negative. These patients had a SLNB prior to the standard ALND regardless of outcome of the SLNB.ResultsTen studies that met the eligibility criteria were identified. A total of 449 patients were studied. Pooled analysis using the fixed effects model was used to calculate successful identification rate and accuracy parameters. The summary rate of identification of SLN was 94% [95% CI: 91.6% – 96.7%]. The pooled sensitivity of SLNB after NAC was 93% [95% CI: 88.5% – 96.8%] and the false negative rate 7.0% [95% CI: 3.2% – 11.5%].ConclusionSLNB in patients with a clinically node negative axilla after neoadjuvant chemotherapy is feasible and accurate. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1013.

Contrast Enhanced Ultrasound (CEU) Using Microbubbles for Sentinel Lymph Node Biopsy in Breast Cancer: a Systematic Review

“…Various studies reported that the SLN identification rate after neo-adjuvant chemotherapy was over 90% while the false-negative rate was almost 10% (30,31). Regardless of the present data, there is concern on the hypothesis that SLN biopsy after neo-adjuvant chemotherapy might increase the number of the false-negative biopsies due to multiple factors such as fibrosis, distorted lymphatic drainage, tissue scarring and not always uniform response of the patients to treatment (32). The definition of the oncologic stage and the lymph node status before the neo-adjuvant chemotherapy seems to be essential for the final prognosis and the major advantage of the SLN biopsy.…”

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

“…To date, 4 metaanalyses that access the accuracy of SLNB after neoadjuvant chemotherapy have been published [24][25][26][27]. Although most of the included studies are limited by small size, retrospective design, and wide variation in results, the sentinel identification rates and false-negative rates determined were similar to those seen in patients undergoing SLNB before chemotherapy [28].…”

Results of the First Austrian Multidisciplinary Expert Panel on Controversies in Local Treatment of Breast Cancer

“…Data supporting this approach is limited to several large retrospective series and meta-analyses, while SNB before nCT is considered to be standard of care [12].…”