Value of Preoperative Ultrasound-Guided Axillary Lymph Node Biopsy for Preventing Completion Axillary Lymph Node Dissection in Breast Cancer: A Systematic Review and Meta-Analysis

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• 作者：Suzanne C. E. Diepstraten MD (1)
  Ali R. Sever MD ; PhD (2)
  Constantinus F. M. Buckens MD (1) (3)
  Wouter B. Veldhuis MD ; PhD (1)
  Thijs van Dalen MD ; PhD (4)
  Maurice A. A. J. van den Bosch MD ; PhD (1)
  Willem P. Th. M. Mali MD ; PhD (1)
  Helena M. Verkooijen MD ; PhD (1)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：21
• 期：1
• 页码：51-59
• 全文大小：430 KB
• 作者单位：Suzanne C. E. Diepstraten MD (1)
  Ali R. Sever MD, PhD (2)
  Constantinus F. M. Buckens MD (1) (3)
  Wouter B. Veldhuis MD, PhD (1)
  Thijs van Dalen MD, PhD (4)
  Maurice A. A. J. van den Bosch MD, PhD (1)
  Willem P. Th. M. Mali MD, PhD (1)
  Helena M. Verkooijen MD, PhD (1)
  
  1. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. Department of Radiology, Maidstone Hospital, Maidstone, Kent, UK
  3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  4. Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
  
• ISSN：1534-4681

文摘

Purpose This meta-analysis was designed to evaluate the utility of preoperative axillary ultrasound combined with US-guided lymph node biopsy if indicated (AUS?±?biopsy), in terms of staging the axilla and preventing two-step axillary surgery in the form of sentinel node biopsy (SNB) followed by completion axillary lymph node (ALN) dissection. Methods We systematically searched electronic databases for studies that addressed preoperative assessment of ALN status by AUS?±?biopsy. A pooled estimate was calculated for the false-negative rate (FNR) of AUS?±?biopsy (defined as the proportion of women with a negative AUS?±?biopsy result subsequently proven to have a positive axilla) and sensitivity (defined as the proportion of women with a positive AUS?±?biopsy result among all women with a tumor positive axilla). Results The pooled FNR was 25?% (95?% confidence interval [CI]?=?24-7) and the pooled sensitivity was 50?% (95?% CI?=?43-7). There was substantial heterogeneity across studies for both FNR (I 2?=?69.42) and sensitivity (I 2?=?93.25), which was not explained by between-study differences in biopsy technique, mean/median tumor size, biopsy indication, or study design. Sensitivity was increased in studies with a high prevalence of ALN metastases. Conclusions Preoperative axillary ultrasound-guided biopsy is a useful step in the process of axillary staging. Approximately 50?% of women with axillary involvement can be identified preoperatively. Still, one in four women with an ultrasound-guided biopsy-“proven-negative axilla has a positive SNB.