Lymphatic mapping and sentinel lymph node (SLN) biopsy in early-stage breast carcinoma
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13.07.2017 • Sonuncu dəyişiklik 13.07.2017
Editors
The incidence of axillary metastases in patients with negative sentinel node biopsy appears to be low. There is a wide variation in reported test performance of sentinel lymph node biopsy, but the false negative rate appears to decrease when the proportion of patients for whom mapping is successful increases.
A systematic review including 69 studies with a total of 8059 subjects was abstracted in DARE. Lymphatic mapping with sentinel lymph node (SLN) biopsy is used widely to reduce the complications associated with complete axillary lymph node dissection in patients with low-risk breast carcinoma. The proportion of patients who had successfully mapped SLNs ranged from 41% to 100%, with over 50% of studies reporting a rate < 90%. The false-negative rate, FNR (the probability of a negative SLN when the patient has a positive axillary lymph node dissection) ranged from 0% to 29%, averaging 7.3% overall. Eleven trials (15.9%) reported an FNR of 0.0, whereas 26 trials (37.7%) reported an FNR > 10%. Significant inverse correlations were observed between the FNR and both the number of patients studied (r = - 0.42; P < 0.01) and the proportion of patients who had successfully mapped SLNs nodes (r = - 0.32; P = 0.009). The authors state that clinicians should be aware of the wide variation in rates of successful mapping and test performance, as well as the need to allow time for learning.
In a randomized trial (n=516) comparing sentinel node biopsy (+ evacuation if sentinel node was positive) (group 1) with sentinel node biopsy followed by evacuation (group 2), axillary metastases were found during surgery in 92 patients in group 1 and 82 patients in group 2. The false negative rate in group 2 was 8.8% (axillary metastases were found at evacuation in 8 patients in whom sentinel node biopsy was negative). During a median follow-up of 46 months, there were no clinical axillary recurrences in either group.
According to 8 observational studies with a median follow-up of 3 – 5 years, the rate of axillary recurrence was about 0.3%.
Comment: The quality of evidence is downgraded by imprecise results (few events in randomized trials). The skill of the operator appears to influence the sensitivity of sentinel node biopsy in detecting axillary metastases.
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