The False‐Negative Rate of Sentinel Node Biopsy in Patients with Breast Cancer: A Meta‐Analysis

Pesek, Sarah; Ashikaga, Taka; Krag, L. E.; Krag, David N.

doi:10.1007/s00268-012-1623-z

Cited by 146 publications

(113 citation statements)

References 247 publications

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“…This was comparable with the reported falsenegative rates of 5 -10% for SNB. 2,3, 14,19 Considering that the major objective of axillary dissection is to obtain information regarding lymph node metastasis, 2,3 and that failure to clear all node metastases in the upper part of the axilla has no impact on prognosis, 7,11,20 these data suggested that partial dissection limited to the area caudal to the intercostobrachial nerve might be FIGURE 2: (A) Overall survival and (B) disease-free survival in patients who underwent breast cancer surgery and partial dissection (group A; n = 1043) or conventional axillary lymph node dissection (group B; n = 1084). There were no significant differences in the overall or disease-free survival rates between the two surgical groups as determined by log rank test (P ≥ 0.05) No significant differences in the 5-year overall or disease-free survival rates between the partial dissection group and the conventional dissection group were observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Partial Lower Axillary Dissection for Patients with Clinically Node-negative Breast Cancer

2012

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OBJECTIVE: To evaluate retrospectively the outcomes of partial lower axillary lymph node dissection caudal to the intercostobrachial nerve in patients with clinically node-negative (N 0 ) breast cancer. METHODS: Numbers of dissected and metastatic nodes, overall and diseasefree survival rates, postoperative complication rates, and axillary recurrence were compared between patients who underwent breast cancer surgery with partial axillary node dissection (n = 1043) and historical controls who underwent conventional dissection (n = 1084). RESULTS: The 5-year overall and disease-free survival rates were 95.6% and 89.7%, and 94.9% and 88.4%, respectively, in the partial dissection and conventional dissection groups; the differences were not significant. Mean duration of surgery (41.6 min versus 60.9 min), intraoperative blood loss (28.0 ml versus 51.3 ml), volume of lymphatic drainage at 2 weeks postoperatively (488 ml versus 836 ml), and persistent arm lymphoedema (0.0% versus 11.8%) were significantly different between the partial and conventional dissection groups, respectively. CONCLUSIONS: Partial axillary lymph node dissection was associated with similar survival rates (but lower postoperative complication rates) compared with conventional axillary dissection and is recommended in patients with N 0 breast cancer.

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Section: Discussionmentioning

confidence: 99%

Partial Lower Axillary Dissection for Patients with Clinically Node-negative Breast Cancer

2012

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“…The minimally invasive technique of the sentinel lymph node biopsy (SLNB) marked an important epoch in the history of breast cancer management [4,5]. The major drawback in performing routine ALND is associated with longterm complications including post-operative lymphedema, paresthesia, neuropathy, seroma formation, chronic shoulder pain, joint disruption, weakness and reduced mobility [2,3,[6][7][8][9]. The SLNB can therefore be used to select breast cancer patients needing total dissection [10], catering for an improved quality of life and shorter hospital stay.…”

Section: Introductionmentioning

confidence: 99%

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Camilleri¹,

Karen²,

Zarb³

2013

JCT

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Over the past two decades, the sentinel lymph node biopsy (SLNB) based on sentinel node (SN) being the first lymph node that harbors metastases, revolutionized breast cancer management. SLNB presents much less morbidity when compared to radical axillary lymph node dissection (ALND) where all nodes are dissected irrespective of their metastatic involvement. The purpose of this study was to evaluate the effectiveness of SLNB by investigating whether the histological characteristics of the SNs identified using scintigraphy are predictive of the histological characteristics of the ALN basin. Methods: Fifty-five female breast cancer patients underwent lymphoscintigraphy and SLNB followed by ALND. The histological status of the SN/s was correlated to the histological status of the ALNs to determine whether the SN accurately stages the ALNs in breast cancer. Results: During surgery, SNs were successfully isolated in 52 out of 55 cases (94.5%) (range, 0 to 9). No SNs were identified in 3 cases (5.5%). Results demonstrate a significant association (p = 0.05) between the metastatic status of SNs and the corresponding ALNs in 42 out of 52 patients (80.8%), but with a high false-negative rate (FNR) of 37.5%. Conclusion: The findings of this study show that the sentinel node concept provides the benefits of SLNB in the majority of instances. However, further work is required in reducing the FNR. Once the effectiveness of SLNB as a staging technique is locally established, the need of ALND in SN-negative patients would be limited, thus improving the quality of life of Maltese breast cancer patients.

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“…A substantial worldwide literature documents low rates of axillary node recurrence (0.3 %), and five randomized trials show no difference between ALND and SLN biopsy in local, regional, or distant control of node-negative disease. [1][2][3][4] Could subsets of SLN-positive patients also avoid ALND? In fact, a policy of selective non-ALND dates back almost to the advent of SLN biopsy.…”

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confidence: 99%

Extending ACOSOG Z0011 to Encompass Mastectomy: What Happens Without RT?

Cody

2016

Ann Surg Oncol

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The initial premise of sentinel lymph node (SLN) biopsy for breast cancer, that patients with negative SLN could safely avoid axillary lymph node dissection (ALND), is well established. A substantial worldwide literature documents low rates of axillary node recurrence (0.3 %), and five randomized trials show no difference between ALND and SLN biopsy in local, regional, or distant control of node-negative disease. 1-4Could subsets of SLN-positive patients also avoid ALND? In fact, a policy of selective non-ALND dates back almost to the advent of SLN biopsy. Bilimoria et al. retrospectively analyzed 403,167 stage I to III breast cancer patients in the National Cancer Data Base (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) and found that 23 % of those with SLN macrometastases (pN1) and 36 % of those with SLN micrometastases (pN1mi) did not have ALND; uncorrected for selection bias, there was no adverse effect on axillary local recurrence or 5-year relative survival. 5Two randomized trials are more definitive, ACOSOG Z0011 was performed for hematoxylin and eosin-detected SLN metastases (cT1-2N0 patients with 1 to 2 positive SLN treated by breast conservation with whole-breast radiotherapy [WBRT]). 6,7 International Breast Cancer Study Group (IBCSG) 23-01 was performed for SLN micrometastases (cT1-2N0 patients with SLN micrometastases \2 mm).8 Each study randomized SLN biopsy alone versus SLN biopsy plus ALND and found no differences in 5-year local, regional, or distant disease-free survival. These results were particularly striking in that ALND identified residual axillary disease in 27 % of the Z0011 and in 13 % of the IBCSG 23-01 patients, yet axillary recurrence at 5 years developed in only 0.9 and 1 %, respectively, of the SLN-only arms. Both trials have been practice changing; at our own institution, 84 % of patients who met the Z0011 selection criteria were able to avoid ALND, and in Europe, ALND is no longer routine for patients with SLN micrometastases. Although Z0011 required WBRT without nodal radiotherapy (RT), a lingering concern is that the excellent results may reflect the use of ''high tangents'' to extend the breast RT field into the axilla. Indeed, an audit of the RT fields in a subset of the Z0011 patients confirmed that about half received high tangents, 17-21 % had supraclavicular RT, and 6-10 % had a posterior axillary boost. (These protocol violations were equally distributed between the study arms). 10Can ALND be avoided for SLN-positive patients outside the Z0011 selection criteria, specifically those who are treated by mastectomy without RT? My colleagues and I first addressed this question in 2012, comparing outcomes in SLN-positive breast cancer patients treated by mastectomy (n = 210) or breast conservation (n = 325) without any axillary-specific treatment.11 At a median follow-up of 5 years, there were no significant differences in the rates of local (1.7 vs. 1.4 %) or regional node recurrence (1.2 vs. 1.0 %) even though 94 % of the breast conservation patients had received WBRT. The...

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The False‐Negative Rate of Sentinel Node Biopsy in Patients with Breast Cancer: A Meta‐Analysis

Cited by 146 publications

References 247 publications

Partial Lower Axillary Dissection for Patients with Clinically Node-negative Breast Cancer

Partial Lower Axillary Dissection for Patients with Clinically Node-negative Breast Cancer

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Extending ACOSOG Z0011 to Encompass Mastectomy: What Happens Without RT?

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