Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Br J Surg. 2018 Nov;105(12):1541-1552. doi: 10.1002/bjs.10986.
Neoadjuvant chemotherapy for breast cancer has the potential to achieve a pathological complete response in up to 40 per cent of patients, converting disease that was initially node-positive to node-negative. This has raised the question of whether sentinel lymph node biopsy could be an alternative to axillary lymph node dissection in these patients. The aim was to undertake a systematic review and meta-analysis of the accuracy and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer.
A literature search was conducted using PubMed, Ovid MEDLINE, Embase and Web of Science databases up to 30 April 2017. Inclusion criteria for studies were pathological confirmation of initial node-positive disease, and sentinel lymph node biopsy performed after neoadjuvant chemotherapy followed by axillary lymph node dissection.
A total of 13 studies met the inclusion criteria and were included in the analysis (1921 patients in total). The pooled estimate of identification rate was 90 (95 per cent c.i. 87 to 93) per cent and the false-negative rate was 14 (11 to 17) per cent. In subgroup analysis, the false-negative rate with use of dual mapping was 11 (6 to 15) per cent, compared with 19 (11 to 27) per cent with single mapping. The false-negative rate was 20 (13 to 27) per cent when one node was removed, 12 (5 to 19) per cent with two nodes removed and 4 (0 to 9) per cent with removal of three or more nodes.
Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with biopsy-proven node-positive breast cancer is accurate and reliable, but requires careful patient selection and optimal surgical techniques.
新辅助化疗有可能使多达 40%的患者达到病理完全缓解，将最初淋巴结阳性的疾病转化为淋巴结阴性。这就提出了一个问题，即在这些患者中，前哨淋巴结活检是否可以替代腋窝淋巴结清扫术。本研究旨在对经新辅助化疗后初始活检证实为淋巴结阳性的乳腺癌患者的前哨淋巴结活检的准确性和可靠性进行系统评价和荟萃分析。
我们使用 PubMed、Ovid MEDLINE、Embase 和 Web of Science 数据库进行了文献检索，检索时间截至 2017 年 4 月 30 日。纳入研究的标准为：初始疾病经病理证实为淋巴结阳性，且新辅助化疗后行前哨淋巴结活检，随后行腋窝淋巴结清扫术。
共有 13 项研究符合纳入标准，并纳入分析（共 1921 例患者）。识别率的合并估计值为 90%（95%可信区间 87%至 93%），假阴性率为 14%（11%至 17%）。在亚组分析中，使用双示踪剂的假阴性率为 11%（6%至 15%），而单示踪剂的假阴性率为 19%（11%至 27%）。当切除 1 个淋巴结时，假阴性率为 20%（13%至 27%），切除 2 个淋巴结时假阴性率为 12%（5%至 19%），切除 3 个或更多淋巴结时假阴性率为 4%（0%至 9%）。
经新辅助化疗后对活检证实为淋巴结阳性的乳腺癌患者行前哨淋巴结活检是准确可靠的，但需要仔细选择患者并采用最佳的手术技术。
