Panel Disdussion

3rd International Congress 3rd International of Nuclear Congress Medicine of Nuclear & 15th Medicine Iranian Annual & 15th Iranian Congress Annual of
Nuclear Congress Medicine of Nuclear Medicine
Shahid Beheshti Shahid Beheshti University University of Medical Sciences of Medical 19-21 Sciences May 201119-21 May 2011
Accuracy of sentinel lymph node biopsy for axillary staging of
breast cancer patients undergone prior surgical biopsy: metaanalysis
of the literature.
Ramin Sadeghi 1 , Hassan Gholami 2 , Hadi Javan 3 , Azar Fani Pakdel 4 ,
Mehdi Asadi 5
1 Mash’had University of Medical Science, Nuclear Medicine Research Center
2 Mash’had University of Medical Science, Evidence Based Medicine Committee
3 Mashhad University of Medical Sciences
4 Mash’had University of Medical Science, Cancer Research Center
5 Mash’had University of Medical Science, Surgical Oncology Research Center
Introduction: Sentinel lymph node biopsy is the standard method of
axillary staging in early stage breast cancer patients. An important
issue is the eligibility of patients undergone prior surgical biopsy of
the primary breast lesion. In this meta-analysis we comprehensively
searched the literature regarding this issue and summarized the
results accordingly.
Materials and methods: We systematically searched Medline,
SCOPUS, and Google Scholar for studies with head to head
comparison of sentinel lymph node biopsy method in patients with
and without prior surgical biopsy. No language or date restriction was
imposed. Studies with enough information to calculate detection rate
as well as false negative rate for both groups were included. For
pooling of the results random effects model was used (Der-Simonian
and Laird method). Q statistics and I2 index were used for
heterogeneity evaluation.
Results: 68 studies for detection rate and 16 for false negative rate
were located with the required information. Pooled detection rates for
patients with and without history of prior surgical biopsy were
91.33% [89.1-93%] and 92.7% [90.9-94.1%] respectively. OR of
unsuccessful mapping was 1.14 [0.955-1.362] and risk difference
was 0.00018 [-0.00844-0.00881] (Q value=104.730 p=0.001 and
I2=38.89). Pooled false negative rates for patients with and without
history of prior surgical biopsy were 13% [9.6%-17.4%] and 10%
[7.6%-12.8%] respectively. OR of getting false negative results was
1.418 [1.107-1.816] and risk difference was 2.2% [0.1%-4.3%] (Q
value=14.12 p=0.516 and I2=0).
Conclusion: Successful sentinel node mapping is not decreased by
prior surgical biopsy of the primary breast lesion. However, the false
negative rate in this group of patients is slightly higher compared to
those without previous biopsy. Despite this fact, the difference is low
(2.2%) and is not clinically relevant. In our opinion prior biopsy of
the primary breast lesions should not be considered as a contraindication
for sentinel lymph node biopsy procedure.
Keywords: Sentinel breast cancer, meta-analysis, core-needlebiopsy,
excisional-biopsy
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