title: The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis.
abstract: BACKGROUND
  In sentinel node surgery for breast cancer, procedural accuracy is assessed by calculating the false-negative rate. It is important to measure this since there are potential adverse outcomes from missing node metastases. We performed a meta-analysis of published data to assess which method has achieved the lowest false-negative rate.
  
  
  METHODS
  We found 3,588 articles concerning sentinel nodes and breast cancer published from 1993 through mid-2011; 183 articles met our inclusion criteria. The studies described in these 183 articles included a total of 9,306 patients. We grouped the studies by injection material and injection location. The false-negative rates were analyzed according to these groupings and also by the year in which the articles were published.
  
  
  RESULTS
  There was significant variation related to injection material. The use of blue dye alone was associated with the highest false-negative rate. Inclusion of a radioactive tracer along with blue dye resulted in a significantly lower false-negative rate. Although there were variations in the false-negative rate according to injection location, none were significant.
  
  
  CONCLUSIONS
  The use of blue dye should be accompanied by a radioactive tracer to achieve a significantly lower false-negative rate. Location of injection did not have a significant impact on the false-negative rate. Given the limitations of acquiring appropriate data, the false-negative rate should not be used as a metric for training or quality control.
authors.affiliation: University of Vermont College of Medicine, Burlington, VT 05405, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pesek
authors.forename: Taka
authors.initials: T
authors.lastname: Ashikaga
authors.forename: Lars Erik
authors.initials: LE
authors.lastname: Krag
authors.forename: David
authors.initials: D
authors.lastname: Krag
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D004396:Coloring Agents; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals