Feasibility and Accuracy of Sentinel Lymph Node Biopsy in Clinically Node-Positive Breast Cancer after Neoadjuvant Chemotherapy: A Meta-Analysis

Abstract

Sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection (ALND) in axillary node-negative breast cancer patients. However, the use of SLNB remains controversial in patients after neoadjuvant chemotherapy (NAC). The aim of this review is to evaluate the feasibility and accuracy of SLNB after NAC in clinically node-positive patients. Systematic searches were performed in the PubMed, Embase, and Cochrane Library databases from 1993 to December 2013 for studies on node-positive breast cancer patients who underwent SLNB after NAC followed by ALND. Of 436 identified studies, 15 were included in this review, with a total of 2,471 patients. The pooled identification rate (IR) of SLNB was 89% [95% confidence interval (CI) 85–93%], and the false negative rate (FNR) of SLNB was 14% (95% CI 10–17%). The heterogeneity of FNR was analyzed by meta-regression, and the results revealed that immunohistochemistry (IHC) staining may represent an independent factor (P = 0.04). FNR was lower in the IHC combined with hematoxylin and eosin (H&E) staining subgroup than in the H&E staining alone subgroup, with values of 8.7% versus 16.0%, respectively (P = 0.001). Thus, SLNB was feasible after NAC in node-positive breast cancer patients. In addition, the IR of SLNB was respectable, although the FNR of SLNB was poor and requires further improvement. These findings indicate that IHC may improve the accuracy of SLNB.

Management of axilla in breast cancer – The saga continues

“…A multicenter prospective study from France reported a lower identification rate and higher false negative rate in clinical node-positive patients compared to node-negative disease at presentation [74]. Given the stark difference between these patient populations, two separate meta-analyses have been reported for cN0 [75] and cN1 [76] patients undergoing post-chemotherapy SLNB and axillary dissection. In 2011, the meta-analysis by Tan et al indicated that for clinically node negative patients, the false negative rate of 7% is similar to the false negative rate in patients without neoadjuvant chemotherapy [75].…”

A Comparative Validation of Primary Surgical Versus Post‐neo‐adjuvant Chemotherapy Sentinel Lymph Node Biopsy for Stage III Breast Cancers

“…A recent meta-analysis has shown that post-NACT SLNB is associated with an acceptable pooled IR (89 %), but a poor FNR (14 %) [20]. This meta-analysis suggested that further studies be undertaken, especially in LABC patients, to identify factors associated with SLNB failure, with the intention of creating a well-defined 'selection criteria' for patients receiving NACT-aiming to achieve IR and FNR equivalent to that of SLNB in EBC patients.…”

Management of the positive axilla in 2017

“…The first one involved 2471 patients and found an IR of 89% and an FNR of 14% [35]. According to the first study, usage of IHC decreased FNR to 8.7%, while without IHC, the FNR was 16%.…”