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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2014

01-01-2014 | Breast Oncology

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

Authors: Suzanne C. E. Diepstraten, MD, Ali R. Sever, MD, PhD, Constantinus F. M. Buckens, MD, Wouter B. Veldhuis, MD, PhD, Thijs van Dalen, MD, PhD, Maurice A. A. J. van den Bosch, MD, PhD, Willem P. Th. M. Mali, MD, PhD, Helena M. Verkooijen, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2014

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Abstract

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] = 24–27) and the pooled sensitivity was 50 % (95 % CI = 43–57). 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.
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Metadata
Title
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
Authors
Suzanne C. E. Diepstraten, MD
Ali R. Sever, MD, PhD
Constantinus F. M. Buckens, MD
Wouter B. Veldhuis, MD, PhD
Thijs van Dalen, MD, PhD
Maurice A. A. J. van den Bosch, MD, PhD
Willem P. Th. M. Mali, MD, PhD
Helena M. Verkooijen, MD, PhD
Publication date
01-01-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 1/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3229-6

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