Fu Jian-Fei, Chen Hai-Long, Yang Jiao, Yi Cheng-Hao, Zheng Shu
Key Laboratory of Cancer Prevention and Intervention, Chinese Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Hangzhou, Zhejiang Province, China; Institute of Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Department of Oncology, Jinhua Central Hospital, Jinhua Hospital of Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China.
Key Laboratory of Cancer Prevention and Intervention, Chinese Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Hangzhou, Zhejiang Province, China; Institute of Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
PLoS One. 2014 Sep 11;9(9):e105316. doi: 10.1371/journal.pone.0105316. eCollection 2014.
Sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection (ALND) in axillary node-negative breast cancer patients. However, the use of SLNB remains controversial in patients after neoadjuvant chemotherapy (NAC). The aim of this review is to evaluate the feasibility and accuracy of SLNB after NAC in clinically node-positive patients. Systematic searches were performed in the PubMed, Embase, and Cochrane Library databases from 1993 to December 2013 for studies on node-positive breast cancer patients who underwent SLNB after NAC followed by ALND. Of 436 identified studies, 15 were included in this review, with a total of 2,471 patients. The pooled identification rate (IR) of SLNB was 89% [95% confidence interval (CI) 85-93%], and the false negative rate (FNR) of SLNB was 14% (95% CI 10-17%). The heterogeneity of FNR was analyzed by meta-regression, and the results revealed that immunohistochemistry (IHC) staining may represent an independent factor (P = 0.04). FNR was lower in the IHC combined with hematoxylin and eosin (H&E) staining subgroup than in the H&E staining alone subgroup, with values of 8.7% versus 16.0%, respectively (P = 0.001). Thus, SLNB was feasible after NAC in node-positive breast cancer patients. In addition, the IR of SLNB was respectable, although the FNR of SLNB was poor and requires further improvement. These findings indicate that IHC may improve the accuracy of SLNB.
前哨淋巴结活检（SLNB）已取代传统腋窝淋巴结清扫术（ALND）用于腋窝淋巴结阴性的乳腺癌患者。然而，新辅助化疗（NAC）后患者使用SLNB仍存在争议。本综述的目的是评估NAC后SLNB在临床淋巴结阳性患者中的可行性和准确性。我们在1993年至2013年12月期间对PubMed、Embase和Cochrane图书馆数据库进行了系统检索，以查找关于NAC后接受SLNB继而进行ALND的淋巴结阳性乳腺癌患者的研究。在436项已识别的研究中，15项被纳入本综述，共有2471例患者。SLNB的汇总识别率（IR）为89%[95%置信区间（CI）85 - 93%]，SLNB的假阴性率（FNR）为14%（95%CI 10 - 17%）。通过Meta回归分析FNR的异质性，结果显示免疫组织化学（IHC）染色可能是一个独立因素（P = 0.04）。在IHC联合苏木精和伊红（H&E）染色亚组中的FNR低于单独H&E染色亚组，分别为8.7%和16.0%（P = 0.001）。因此，NAC后SLNB在淋巴结阳性乳腺癌患者中是可行的。此外，SLNB的IR可观，尽管其FNR较差且需要进一步改善。这些发现表明IHC可能提高SLNB的准确性。
