Radiology alliance health services researchBreast Cancer: Sentinel Node Identification and Classification after Neoadjuvant Chemotherapy—Systematic Review and Meta Analysis
Section snippets
Study Search Strategy
We conducted this meta-analysis using guidelines from the Quality of Reports of Meta-analyses of Randomized Controlled Trials statement (44). A computerized search was performed to identify relevant articles in human subjects that evaluated sentinel node mapping of axillary lymph nodes in breast cancer following chemotherapy (between 1966 and December 2007) in the MEDLINE, EMBASE, PubMed, Web of Science, Current Concepts Medicine, and the Cochrane Library. The search was conducted using
Study Identification
A total of 1221 unique citations on preoperative or neoadjuvant chemotherapy of breast cancer and 3051 on sentinel node biopsy or mapping or localization or identification were retrieved from the initial search. Of these, 19 prospective 18, 19, 21, 22, 23, 26, 27, 28, 29, 30, 31, 33, 34, 35, 36, 37, 38, 39, 41 and five retrospective 20, 24, 25, 32, 40 trials met our inclusion criteria. The most common reasons for exclusion were use of non-human specimens, non-original research papers, and
Discussion
One in eight women in the United States will develop breast cancer by the age of 70 years 51, 52. Breast cancer accounts for one third of all cancer incidence in women (2). Radiology plays a central role in diagnosis, monitoring treatment response, and follow-up for breast cancer. The most common site for metastases is the ipsilateral axilla. Axillary lymph node dissection is recommended by the National Cancer Institute for all patients with invasive breast cancer 15, 53. SLNB has been proposed
Conclusion
The present systematic review demonstrates robust estimates of successful identification rate and FNR of sentinel lymph node mapping and biopsy after neoadjuvant therapy for early-stage breast cancer patients. With a 90% SIR and 8% FNR, this technique is a reliable tool for planning treatment in this population as an alternative to completion ALND, particularly in practice settings that can accommodate same-day mapping and surgical dissection.
References (53)
- et al.
Meta-analysis of sentinel lymph node biopsy in breast cancer
J Surg Res
(1999) - et al.
Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity
Ann Oncol
(2000) - et al.
Sentinel node in the era of neoadjuvant therapy and locally advanced breast cancer
Surg Oncol
(2003) - et al.
Sentinel lymph node biopsy following neoadjuvant chemotherapy: review of the literature and recommendations for use in patient management
Asian J Surg
(2004) - et al.
A comparison of sentinel node biopsy before and after neoadjuvant chemotherapy: timing is important
Am J Surg
(2005) - et al.
Accuracy of selective sentinel lymphadenectomy after neoadjuvant chemotherapy: effect of clinical node status at presentation
J Am Coll Surg
(2004) - et al.
Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study
Eur J Surg Oncol
(2003) - et al.
Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer
Am J Surg
(2001) Sentinel lymph node biopsy after neoadjuvant systemic therapy
Surg Clin North Am
(2003)- et al.
Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses
Lancet
(1999)
Annual report to the nation on the status of cancer, 1975–2002, featuring population-based trends in cancer treatment
J Natl Cancer Inst
Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control
J Natl Cancer Inst
Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases
Cancer
Management and survival of female breast cancer: results of a national survey by the American College of Surgeons
Cancer
Complications of axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey
Cancer
Complications and local recurrence following lymphadenectomy
Br J Surg
Lymphatic mapping and sentinel lymphadenectomy for breast cancer
Ann Surg
Sentinel lymph node mapping in early-stage breast cancer: technical issues and results with vital blue dye mapping and radioguided surgery
J Surg Oncol
The concept of the sentinel lymph node
Recent Results Cancer Res
Accuracy of sentinel lymph node biopsy for the assessment of axillary status in patients with early (T1) breast carcinoma
J Coll Physicians Surg Pak
American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer
J Clin Oncol
Evidence-based use of neoadjuvant taxane in operable and inoperable breast cancer
Clin Cancer Res
Feasibility of sentinel node biopsy for breast cancer after neoadjuvant endocrine therapy: a pilot study
J Surg Oncol
Lymphatic mapping and sentinel lymphadenectomy after preoperative therapy for stage II and III breast cancer
Ann Surg Oncol
Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer
Breast J
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Funded in part by the NIH/NCI 1 K07 CA108664 01A1 and the GE-AUR Radiology Research Academic Fellowship.