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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.
Highlights
The presence of axillary lymph node metastases, as one of the strongest predictors of survival, is necessary for accurate staging and the selection of local and systemic adjuvant therapies [1,2,3]
In clinically node-negative patients, sentinel lymph node biopsy (SLNB), as a minimally invasive staging tool, can predict the status of axillary lymph nodes with an identification rate (IR) of more than 90% and a false negative rate (FNR) of less than 10%[5,6]
Classe and colleagues confirmed that node-positive patients prior to neoadjuvant chemotherapy (NAC) exhibited a higher FNR than node-negative patients[16]
Summary
The presence of axillary lymph node metastases, as one of the strongest predictors of survival, is necessary for accurate staging and the selection of local and systemic adjuvant therapies [1,2,3]. In clinically node-negative patients, sentinel lymph node biopsy (SLNB), as a minimally invasive staging tool, can predict the status of axillary lymph nodes with an identification rate (IR) of more than 90% and a false negative rate (FNR) of less than 10%[5,6]. The clinical trials of ACOSOG Z0010 and Z0011 indicated that the use of SLNB for staging axillary lymph nodes exhibited a similar relapse rate in comparison with ALND[7,8]. For clinically node-negative patients, SLNB has replaced ALND as the standard procedure to address axillary lymph node status. Neoadjuvant chemotherapy (NAC) has played an increasingly important role in the comprehensive treatment of locally advanced breast cancer[9,10]
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