TY - JOUR
T1 - Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients
T2 - A systematic review
AU - van Deurzen, Carolien H.M.
AU - Vriens, Birgit E.P.J.
AU - Tjan-Heijnen, Vivianne C.G.
AU - van der Wall, Elsken
AU - Albregts, Mirjam
AU - van Hilligersberg, Richard
AU - Monninkhof, Evelyn M.
AU - van Diest, Paul J.
PY - 2009/12/1
Y1 - 2009/12/1
N2 - Background: As neoadjuvant chemotherapy (NAC) is increasingly used to downstage patients with breast cancer, the timing of the sentinel node (SN) biopsy has become an important issue. This review was conducted to determine the accuracy of SN biopsy following NAC. Methods: We searched Medline, Embase and Cochrane databases from 1993 to February 2009 for studies on patients with invasive breast cancer who underwent SN biopsy after NAC followed by an axillary lymph node dissection (ALND). Results: Of 574 eligible studies, 27 were included in this review with a total study population of 2148 patients. The pooled SN identification rate was 90.9% (95% confidence interval (CI) = 88.0-93.1%) and the false-negative rate was 10.5% (95% CI = 8.1-13.6%). Negative predictive value and accuracy after NAC were 89.0% (95% CI = 85.1-92.1%) and 94.4% (95% CI = 92.6-95.8%), respectively. The reported SN success rates were heterogeneous and several variables were reported to be associated with decreased SN accuracy, i.e. initially positive clinical nodal status. Conclusions: There is a potential role for SN biopsy following NAC which could be considered on an individual basis. However, there is insufficient evidence to recommend this as a standard procedure. Further research with subgroup analysis using variables reported to be associated with decreased SN accuracy is required in order to clearly define its value in the subgroups of breast cancer patients.
AB - Background: As neoadjuvant chemotherapy (NAC) is increasingly used to downstage patients with breast cancer, the timing of the sentinel node (SN) biopsy has become an important issue. This review was conducted to determine the accuracy of SN biopsy following NAC. Methods: We searched Medline, Embase and Cochrane databases from 1993 to February 2009 for studies on patients with invasive breast cancer who underwent SN biopsy after NAC followed by an axillary lymph node dissection (ALND). Results: Of 574 eligible studies, 27 were included in this review with a total study population of 2148 patients. The pooled SN identification rate was 90.9% (95% confidence interval (CI) = 88.0-93.1%) and the false-negative rate was 10.5% (95% CI = 8.1-13.6%). Negative predictive value and accuracy after NAC were 89.0% (95% CI = 85.1-92.1%) and 94.4% (95% CI = 92.6-95.8%), respectively. The reported SN success rates were heterogeneous and several variables were reported to be associated with decreased SN accuracy, i.e. initially positive clinical nodal status. Conclusions: There is a potential role for SN biopsy following NAC which could be considered on an individual basis. However, there is insufficient evidence to recommend this as a standard procedure. Further research with subgroup analysis using variables reported to be associated with decreased SN accuracy is required in order to clearly define its value in the subgroups of breast cancer patients.
KW - Breast cancer
KW - Neoadjuvant chemotherapy
KW - Review
KW - Sentinel lymph node biopsy
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U2 - 10.1016/j.ejca.2009.08.001
DO - 10.1016/j.ejca.2009.08.001
M3 - Article
C2 - 19716287
AN - SCOPUS:70450159144
VL - 45
SP - 3124
EP - 3130
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
IS - 18
ER -