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

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.