title: Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer.
abstract: BACKGROUND
  Recent studies show that not all patients with breast cancer and positive axillary lymph nodes need additional axillary surgery. A systematic review and meta-analysis of the literature was performed to test the hypothesis that ultrasound-guided biopsy of suspicious nodes can be a useful tool to identify patients with extensive axillary tumour burden.
  
  
  METHODS
  PubMed and Embase were searched to identify articles reporting on ultrasound-guided techniques to stage the axilla of patients with breast cancer. The emphasis was to study the number of positive nodes found after axillary lymph node dissection (ALND) following a positive ultrasound-guided biopsy or a positive sentinel lymph node biopsy (SLNB). Information regarding the number of positive nodes thus had to be available. Results were tested for heterogeneity and a meta-analysis was performed.
  
  
  RESULTS
  A total of 894 articles were identified, and 115 were selected based on title and abstract information by two independent reviewers. After extensive review, 18 articles were eligible for analysis. Eight studies reported sufficient data to perform a meta-analysis comparing 532 patients with a positive ultrasound-guided biopsy with 248 patients with a negative ultrasound-guided biopsy but a positive SLNB. The number of involved nodes was significantly higher in patients in whom axillary metastasis was detected by ultrasound-guided biopsy (P < 0·001). No heterogeneity in the observed effect was found (I(2)  = 22 per cent, P = 0·26).
  
  
  CONCLUSIONS
  Patients with breast cancer in whom axillary metastases are detected by ultrasound-guided biopsy have significantly more involved nodes than SLNB-positive patients. This finding enables further preoperative tailoring of axillary treatment in breast cancer.
authors.affiliation: Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: B J
authors.initials: BJ
authors.lastname: van Wely
authors.forename: J H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: C
authors.initials: C
authors.lastname: Francissen
authors.forename: S
authors.initials: S
authors.lastname: Teerenstra
authors.forename: L J A
authors.initials: LJ
authors.lastname: Strobbe
mesh_terms: D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D015331:Cohort Studies; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D007267:Injections; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods; D011849:Radioactive Tracers; D011868:Radioisotopes / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D047368:Tumor Burden; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D004396:Coloring Agents; D011849:Radioactive Tracers; D011868:Radioisotopes