Outcomes of Sentinel Node Biopsy for Women with Breast Cancer After Neoadjuvant Therapy: Systematic Review and Meta-Analysis of Real-World Data

Lin, Shi-Qian; Vo, Nguyen-Phong; Yen, Yu-Chun; Tam, Ka‐Wai

doi:10.1245/s10434-021-11297-z

Cited by 13 publications

(7 citation statements)

References 89 publications

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“…While no difference in this outcome was reported with regard to baseline axillary status, previous literature suggests that radioisotope ± blue dye outperforms blue dye alone 4 , 5 , 13 , 14 , 19 . In the present study, SPIO detection was very high and was not affected by baseline axillary status, a finding consistent with previous reports 20 , whereas radioisotope-based detection was comparable to the available literature 17 . The negative interaction between high BMI and SPIO detection does not seem to be tracer-specific, as high BMI has been identified as a challenge for other tracers as well 18 , 21 .…”

Section: Discussionsupporting

confidence: 93%

“…Initial concerns have largely been abandoned, as it has been shown that ypN is a stronger prognosticator than cN 15 , 16 . In two meta-analyses, conducted in 2009 and 2022, the pooled SLND rate was, however, 90.9% and 90.6% respectively, with significant heterogeneity ( I 2 = 89%) 17 , 18 . While no difference in this outcome was reported with regard to baseline axillary status, previous literature suggests that radioisotope ± blue dye outperforms blue dye alone 4 , 5 , 13 , 14 , 19 .…”

Section: Discussionmentioning

confidence: 96%

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Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Pantiora,

Eriksson,

Wärnberg

et al. 2024

British Journal of Surgery

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Background Superparamagnetic iron nanoparticles perform comparably to radioisotope ± blue dye for sentinel lymph node detection in breast cancer, even when injected up to 8 weeks before surgery. Using superparamagnetic iron nanoparticles for sentinel lymph node detection after primary systemic therapy, and the maximum time frame of superparamagnetic iron nanoparticle administration have not been investigated. Methods This cohort study included cN0/1-to-ycN0 patients undergoing sentinel lymph node detection or targeted axillary dissection. All patients received superparamagnetic iron nanoparticles either before primary systemic therapy or before surgery, and radioisotope on the day of surgery. Results For 113 patients analysed, superparamagnetic iron nanoparticles were injected a median of 3 (range 0–248) days before surgery, with a 97.4% detection rate compared with 91.2% for radioisotope (P = 0.057). Concordance for radioisotope was 97.1% and this was not affected by timing of superparamagnetic iron nanoparticle injection (Kendall’s tau 0.027; P = 0.746). The median sentinel lymph node yield was 3 (interquartile range (i.q.r.) 2–3) for superparamagnetic iron nanoparticles and 2 (i.q.r. 2–3) for radioisotope (P < 0.001). In targeted axillary dissection, detection was 100% for superparamagnetic iron nanoparticles and 81.8% for radioisotope (P = 0.124). The index node was magnetic in 93.9% and radioactive in 66.7% (P = 0.007), an outcome that was not affected by any factors. For patients with metastases, superparamagnetic iron nanoparticle detection was 100% and radioisotope-based detection was 84.2% (P = 0.083), with superparamagnetic iron nanoparticles detecting more metastatic sentinel lymph nodes (median of 1 (i.q.r. 1–2) for superparamagnetic iron nanoparticles compared with a median of 1 (i.q.r. 0–1) for radioisotope; P = 0.005). Conclusion Injection before primary systemic therapy is feasible and does not affect concordance with radioisotope. Superparamagnetic iron nanoparticles perform comparably to radioisotope, but detect more sentinel lymph nodes and have a higher rate of detection of metastatic sentinel lymph nodes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Pantiora,

Eriksson,

Wärnberg

et al. 2024

British Journal of Surgery

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“…However, the St. Gallen Consensus Panel in 2017 (25) and the German AGO recommendation in 2022 (26) recommend SLNB as the standard surgical procedure for patients who present with cN0 before and after NAC. In patients who are cN+ and achieved nodal pCR after NAC, ALND is still performed in clinical practice in some cases because of the unacceptable identification rate and FNR of SLNB (7)(8)(9)27).…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of NAC has enabled selected women to undergo breast-conserving surgery (BCS) in the last two decades; however, for patients who received NAC, the chance of de-escalated axillary surgery has not improved (6). The National Comprehensive Cancer Network (NCCN) breast cancer guidelines recommend SLNB for patients with cN0 to ycN0 disease after NAC, but ALND is still recommended for patients who are converted from cN+ to cN0, and SLNB is usually considered a relative contraindication due to its low identification rate and high false-negative rate (FNR) (7,8). In the SENTinel NeoAdjuvant (SENTINA) study (9), the detection rate of SLNB after NAC in patients with cN+ to cN0 disease was 80.1% (95% CI 76.6-83.2), and the false-negative rate was 14.2% (95% CI 9.9-19.4).…”

Section: Introductionmentioning

confidence: 99%

A nomogram for predicting pathologic node negativity after neoadjuvant chemotherapy in breast cancer patients: a nationwide, multicenter retrospective cohort study (CSBrS-012)

Maimaitiaili,

Li,

Chai

et al. 2024

Front. Oncol.

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PurposeThis study aimed to investigate the factors associated with pathologic node-negativity (ypN0) in patients who received neoadjuvant chemotherapy (NAC) to develop and validate an accurate prediction nomogram.MethodsThe CSBrS-012 study (2010–2020) included female patients with primary breast cancer treated with NAC followed by breast and axillary surgery in 20 hospitals across China. In the present study, 7,711 eligible patients were included, comprising 6,428 patients in the primary cohort from 15 hospitals and 1,283 patients in the external validation cohort from five hospitals. The hospitals were randomly assigned. The primary cohort was randomized at a 3:1 ratio and divided into a training set and an internal validation set. Univariate and multivariate logistic regression analyses were performed on the training set, after which a nomogram was constructed and validated both internally and externally.ResultsIn total, 3,560 patients (46.2%) achieved ypN0, and 1,558 patients (20.3%) achieved pathologic complete response in the breast (bpCR). A nomogram was constructed based on the clinical nodal stage before NAC (cN), ER, PR, HER2, Ki67, NAC treatment cycle, and bpCR, which were independently associated with ypN0. The area under the receiver operating characteristic curve (AUC) for the training set was 0.80. The internal and external validation demonstrated good discrimination, with AUCs of 0.79 and 0.76, respectively.ConclusionWe present a real-world study based on nationwide large-sample data that can be used to effectively screen for ypN0 to provide better advice for the management of residual axillary disease in breast cancer patients undergoing NAC.

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“…Thus, the absence of a specific QA tool can restrict the process of consistent and reliable appraisal for SRs and MAs studies that have used RWD. In the current review, the authors observed that some of the QA tools were adapted or modified [ 23 , 32 , 34 , 36 ], whereas others used generic QA tools. Overall, little consensus was observed around the QA tools of the SRs and MAs for RWE studies.…”

Section: Discussionmentioning

confidence: 99%

A scoping review on quality assessment tools used in systematic reviews and meta-analysis of real-world studies

et al. 2023

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Risk of bias tools is important in identifying inherent methodical flaws and for generating evidence in studies involving systematic reviews (SRs) and meta-analyses (MAs), hence the need for sensitive and study-specific tools. This study aimed to review quality assessment (QA) tools used in SRs and MAs involving real-world data. Electronic databases involving PubMed, Allied and Complementary Medicine Database, Cumulated Index to Nursing and Allied Health Literature, and MEDLINE were searched for SRs and MAs involving real-world data. Search was delimited to articles published in English, and between inception to 20 of November 2022 following the SRs and MAs extension for scoping checklist. Sixteen articles on real-world data published between 2016 and 2021 that reported their methodological quality met the inclusion criteria. Seven of these articles were observational studies, while the others were of interventional type. Overall, 16 QA tools were identified. Except one, all the QA tools employed in SRs and MAs involving real-world data are generic, and only three of these were validated. Generic QA tools are mostly used for real-world data SRs and MAs, while no validated and reliable specific tool currently exist. Thus, there is need for a standardized and specific QA tool of SRs and MAs for real-world data.

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Outcomes of Sentinel Node Biopsy for Women with Breast Cancer After Neoadjuvant Therapy: Systematic Review and Meta-Analysis of Real-World Data

Cited by 13 publications

References 89 publications

Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

A nomogram for predicting pathologic node negativity after neoadjuvant chemotherapy in breast cancer patients: a nationwide, multicenter retrospective cohort study (CSBrS-012)

A scoping review on quality assessment tools used in systematic reviews and meta-analysis of real-world studies

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