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Abstract
BackgroundWith the increased use of neoadjuvant chemotherapy (NAC) in breast cancer, the timing of sentinel lymph node biopsy (SLNB) has become increasingly important. In this study, we aimed to evaluate the feasibility and accuracy of SLNB for initially clinically node-negative breast cancer after NAC by conducting a systematic review and meta-analysis.MethodsWe searched PubMed, Embase, and the Cochrane Library from January 1, 1993 to November 30, 2015 for studies on initially clinically node-negative breast cancer patients who underwent SLNB after NAC followed by axillary lymph node dissection (ALND).ResultsA total of 1,456 patients from 16 studies were included in this review. The pooled identification rate (IR) for SLNB was 96% [95% confidence interval (CI): 95%-97%], and the false negative rate (FNR) was 6% (95% CI: 3%-8%). The pooled sensitivity, negative predictive value (NPV) and accuracy rate (AR) were 94% (95% CI: 92%-97%, I2 = 27.5%), 98% (95% CI: 98%-99%, I2 = 42.7%) and 99% (95% CI: 99%-100%, I2 = 32.6%), respectively. In the subgroup analysis, no significant differences were found in either the IR of an SLNB when different mapping methods were used (P = 0.180) or in the FNR between studies with and without immunohistochemistry (IHC) staining (P = 0.241).ConclusionBased on current evidence, SLNB is technically feasible and accurate enough for axillary staging in initially clinically node-negative breast cancer patients after NAC.
Highlights
Molecular mechanisms increasingly contribute to our understanding of breast cancer, the status of the axilla remains the most important prognostic factor for breast cancer patients [1,2,3]
We searched PubMed, Embase, and the Cochrane Library from January 1, 1993 to November 30, 2015 for studies on initially clinically node-negative breast cancer patients who underwent Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) followed by axillary lymph node dissection (ALND)
The pooled identification rate (IR) for SLNB was 96% [95% confidence interval (CI): 95%-97%], and the false negative rate (FNR) was 6%
Summary
Molecular mechanisms increasingly contribute to our understanding of breast cancer, the status of the axilla remains the most important prognostic factor for breast cancer patients [1,2,3]. Evaluating the status of the axilla in invasive breast cancer is important for both the prognosis and adjuvant treatment recommendations. Sentinel lymph node biopsy (SLNB), a minimally invasive procedure, was introduced in the early 1990s [7]. SLNB has been studied extensively and recommended as an alternative to traditional ALND for axillary status staging in patients with early breast cancer [9,10,11]. With the increased use of neoadjuvant chemotherapy (NAC) in breast cancer, the timing of sentinel lymph node biopsy (SLNB) has become increasingly important. We aimed to evaluate the feasibility and accuracy of SLNB for initially clinically node-negative breast cancer after NAC by conducting a systematic review and meta-analysis
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