Accuracy of sentinel lymph node biopsy in male breast cancer: Systematic review and meta-analysis

Abstract

Background: Sentinel lymph node biopsy (SLNB) is commonly used in the surgical management of male breast cancer. Contrary to female breast cancer, limited data exist about its performance in male breast cancer. The objective of this systematic review and meta-analysis was to evaluate the SLNB accuracy in male breast cancer.

Methods: MEDLINE, EMBASE, Web of Science and The Cochrane Library were searched from January 1995 to April 2023 for studies evaluating the SLNB identification rate and false-negative rate in male breast cancer with negative preoperative axillary evaluation and primary surgery. For SLNB false-negative rate, the gold standard was the histology of axillary lymph node dissection (ALDN). Methodological quality was assessed by using the QUADAS-2 tool. Pooled estimates of the SLNB identification rate and false-negative rate were calculated. Heterogeneity of the pooled studies was evaluated using I² index.

Results: A total of 12 retrospective studies were included. The 12 studies that reported the SLNB identification rate gathered a total of 164 patients; the 5 studies that reported the SLNB false-negative rate gathered a total of 50 patients with a systematic ALND. The pooled estimate of the SLNB identification rate was 99.0%. The SLNB false-negative rates were 0% in the 5 included studies and consequently so as the pooled estimate of the false-negative rate with no heterogeneity.

Conclusion: SLNB for male breast cancer, following negative preoperative axillary assessment and primary surgery, appears feasible, consistent, and effective. Our research supports conducting immediate SLNB histological evaluation to facilitate prompt ALND in case of positive results.

Keywords: Accuracy; False-negative rate; Identification rate; Male breast cancer; Meta-analysis; Sentinel lymph node biopsy; Systematic review.

Fig. 1

PRISMA flow chart of the study selection process.

Fig. 2

QUADAS-2 risk of bias and applicability concerns.

Fig. 3

Forest plot of the SLNB identification rate. Identification rates are reported with 95% confidence intervals. The pooled estimate rate was 99.0% (95% CI 97.1%–101.0%). The heterogeneity score (I²) was 0.00% (p = 0.85).