van Nijnatten T J A, Schipper R J, Lobbes M B I, Nelemans P J, Beets-Tan R G H, Smidt M L
Department of Radiology, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
Department of Radiology, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
Eur J Surg Oncol. 2015 Oct;41(10):1278-87. doi: 10.1016/j.ejso.2015.07.020. Epub 2015 Aug 22.
To provide a systematic review and meta-analysis of studies investigating sentinel lymph node biopsy after neoadjuvant systemic therapy in pathologically confirmed node positive breast cancer patients.
Pubmed and Embase databases were searched until June 19th, 2015. All abstracts were read and data extraction was performed by two independent readers. A random-effects model was used to pool the proportion for identification rate, false-negative rate (FNR) and axillary pCR with 95% confidence intervals. Subgroup analyses affirmed potential confounders for identification rate and FNR.
A total of 997 abstracts were identified and eventually eight studies were included. Pooled estimates were 92.3% (90.8-93.7%) for identification rate, 15.1% (12.7-17.6%) for FNR and 36.8% (34.2-39.5%) for axillary pCR. After subgroup analysis, FNR is significantly worse if one sentinel node was removed compared to two or more sentinel nodes (23.9% versus 10.4%, p = 0.026) and if studies contained clinically nodal stage 1-3, compared to studies with clinically nodal stage 1-2 patients (21.4 versus 13.1%, p = 0.049). Other factors, including single tracer mapping and the definition of axillary pCR, were not significantly different.
Based on current evidence it seems not justified to omit further axillary treatment in every clinically node positive breast cancer patients with a negative sentinel lymph node biopsy after neoadjuvant systemic therapy.
对病理确诊为淋巴结阳性的乳腺癌患者在新辅助全身治疗后进行前哨淋巴结活检的相关研究进行系统评价和荟萃分析。
检索截至2015年6月19日的Pubmed和Embase数据库。所有摘要均被阅读，数据提取由两名独立的读者进行。采用随机效应模型汇总识别率、假阴性率（FNR）和腋窝病理完全缓解率（pCR）及其95%置信区间。亚组分析确定了识别率和FNR的潜在混杂因素。
共识别出997篇摘要，最终纳入8项研究。汇总估计识别率为92.3%（90.8 - 93.7%），FNR为15.1%（12.7 - 17.6%），腋窝pCR为36.8%（34.2 - 39.5%）。亚组分析后发现，与切除两个或更多前哨淋巴结相比，切除一个前哨淋巴结时FNR显著更差（23.9%对10.4%，p = 0.026）；与临床淋巴结分期为1 - 2期的患者的研究相比，临床淋巴结分期为1 - 3期的研究中FNR更差（21.4%对13.1%，p = 0.049）。其他因素（包括单示踪剂定位和腋窝pCR的定义）无显著差异。
基于目前的证据，对于新辅助全身治疗后前哨淋巴结活检阴性的每一位临床淋巴结阳性乳腺癌患者，省略进一步的腋窝治疗似乎不合理。
