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. 2022 Sep;24(9):1744-1754.
doi: 10.1007/s12094-022-02824-9. Epub 2022 Apr 12.

The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview

Juan C Vázquez  1 , Antonio Piñero  2 , Francisco Javier de Castro  3 , Ana Lluch  4 , Miguel Martín  5 , Agustí Barnadas  6 , Emilio Alba  7 , Álvaro Rodríguez-Lescure  8 , Federico Rojo  9 , Julia Giménez  10 , Iván Solá  11 , María Jesús Quintana  11 , Xavier Bonfill  12 , Gerard Urrutia  12 , Pedro Sánchez-Rovira  13
Affiliations

The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview

Juan C Vázquez et al. Clin Transl Oncol. 2022 Sep.

Abstract

Purpose: We conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs.

Methods: MEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews.

Results: Six systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13-14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes.

Conclusions: It would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. PROSPERO registration number: CRD42020114403.

Keywords: Breast cancer; Neoadjuvant chemotherapy; Preoperative chemotherapy; Sentinel lymph node.

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