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.
BACKGROUND
The use of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC) in patients presenting with clinically positive lymph nodes remains controversial.


METHODS
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).


RESULTS
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).


CONCLUSIONS
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 London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
Hiba
H
El Hage Chehade
The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
Hannah
H
Headon
The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
Omar
O
El Tokhy
The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
Jennifer
J
Heeney
The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
Abdul
A
Kasem
The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK. Electronic address: kefahmokbel@hotmail.com.
Kefah
K
Mokbel
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D018570:Risk Assessment; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000706:statistics & numerical data; D016019:Survival Analysis
Breast cancer; Neoadjuvant chemotherapy; Node positive; Sentinel lymph node biopsy