Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients

• Published in: The American journal of surgery 2016-11, Vol.212 (5), p.969-981
• Main Authors: El Hage Chehade, Hiba, Headon, Hannah, El Tokhy, Omar, Heeney, Jennifer, Kasem, Abdul, Mokbel, Kefah
• Format: Article
• Language: English
• Subjects: Adult; Aged; Axilla; Bias; Biopsy; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Cancer therapies; Chemotherapy; False Negative Reactions; Female; Humans; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic system; Mastectomy - methods; Medical prognosis; Middle Aged; Neoadjuvant chemotherapy; Neoadjuvant Therapy - methods; Neoplasm Invasiveness - pathology; Neoplasm Staging; Node positive; Prognosis; Risk Assessment; Sentinel Lymph Node - pathology; Sentinel lymph node biopsy; Sentinel Lymph Node Biopsy - methods; Sentinel Lymph Node Biopsy - statistics & numerical data; Statistical analysis; Studies; Survival Analysis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.07.018

The use of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC) in patients presenting with clinically positive lymph nodes remains controversial. A computer-aided search of the literature regarding SLNB in clinically node-positive breast cancer treated with NAC was carried out to identify the false negative rate (FNR), sentinel lymph node identification rate (IR), and axillary pathological complete response (pCR). Nineteen articles were used in the analysis yielding 3,398 patients. The pooled estimate of the FNR was 13% and that of the IR was 91%. The adjusted pCR rate was 47%. A trend toward significance was observed with only clinical stage N1 (cN1) disease whereby clinical stage N1 was associated with an increased pCR rate when compared to N2 or N3 disease (P = .06). SLNB after NAC in biopsy-proven node-positive patients results in reasonably acceptable FNR and IR, making it a valid alternative management strategy to axillary dissection. More refined patient selection and optimal techniques can improve the FNR and IR in this patient population. •The pooled estimate of false negative rate was 13%.•The pooled estimate of identification rate was 91%.•The adjusted pathological complete response rate was 47%.•There was a trend toward significance with only cN1 disease.•SLNB post NAC in node-positive patients is a valid alternative strategy to ALND.