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British Medical Bulletin Dec 2021Winged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Winged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper extremity's function and poor performance in daily activities.
SOURCES OF DATA
A systematic review and meta-analysis were performed following the PRISMA guidelines. Two independent reviewers searched PubMed, Embase and Virtual Health Library databases from January 1, 2000 to December 1, 2020. Clinical studies evaluating the diagnosis and epidemiology of WS among breast cancer surgery (BCS) patients were included.
AREAS OF AGREEMENT
The diagnosis of WS relies almost entirely on physical assessment. Studies have suggested a high variability in the report of the incidence of WS given the subjectivity of its diagnosis, and the different criteria used during clinical assessment.
AREAS OF CONTROVERSY
The diagnosis of WS in BCS patients remains a challenge given the lack of standardized diagnostic protocols. Physical examination cannot rely on one manoeuvre only, as it may overlook patients with subtle injuries or overweight and contributing to the underreporting of its incidence.
GROWING POINTS
BCS patients undergoing axillary lymph node dissection experience a significantly higher incidence of WS than those undergoing sentinel lymph node dissection. The global incidence of WS after BCS is 16.79%. Additionally, the anterior flexion test and the push-up test are the most commonly performed diagnostic manoeuvers.
AREAS TIMELY FOR DEVELOPING RESEARCH
Further studies should aim for objective diagnostic tests, especially when the condition is not evident.
Topics: Axilla; Breast Neoplasms; Female; Humans; Incidence; Lymph Node Excision; Scapula; Sentinel Lymph Node Biopsy
PubMed: 34471931
DOI: 10.1093/bmb/ldab021 -
Breast Cancer (Tokyo, Japan) Jul 2023Various surgical energy devices are used for axillary lymph-node dissection. However, those that reduce seroma during axillary lymph-node dissection are unknown. We... (Meta-Analysis)
Meta-Analysis Review
Various surgical energy devices are used for axillary lymph-node dissection. However, those that reduce seroma during axillary lymph-node dissection are unknown. We aimed to determine the best surgical energy device for reducing seroma by performing a network meta-analysis to synthesize the current evidence on the effectiveness of surgical energy devices for axillary node dissection for breast cancer patients. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform Search Portal. Two reviewers independently selected randomized controlled trials (RCTs) comparing electrosurgical bipolar vessel sealing (EBVS), ultrasonic coagulation shears (UCS), and conventional techniques for axillary node dissection. Primary outcomes were seroma, drained fluid volume (mL), and drainage duration (days). We analyzed random-effects and Bayesian network meta-analyses. We evaluated the confidence of each outcome using the CINeMA tool. We registered with PROSPERO (CRD42022335434). We included 34 RCTs with 2916 participants. Compared to the conventional techniques, UCS likely reduces seroma (risk ratio [RR], 0.61; 95% credible interval [CrI], 0.49-0.73), the drained fluid volume (mean difference [MD], - 313 mL; 95% CrI - 496 to - 130), and drainage duration (MD - 1.79 days; 95% CrI - 2.91 to - 0.66). EBVS might have little effect on seroma, the drained fluid volume, and drainage duration compared to conventional techniques. UCS likely reduce seroma (RR 0.44; 95% CrI 0.28-0.69) compared to EBVS. Confidence levels were low to moderate. In conclusion, UCS are likely the best surgical energy device for seroma reduction during axillary node dissection for breast cancer patients.
Topics: Humans; Female; Network Meta-Analysis; Breast Neoplasms; Seroma; Lymph Node Excision; Drainage; Axilla
PubMed: 37058224
DOI: 10.1007/s12282-023-01460-7 -
Journal of Magnetic Resonance Imaging :... Dec 2020Axillary lymph node metastases (ALNM) is one of the most important prognostic factors in breast cancer. Positron emission tomography / computed tomography (PET/CT) and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Axillary lymph node metastases (ALNM) is one of the most important prognostic factors in breast cancer. Positron emission tomography / computed tomography (PET/CT) and magnetic resonance imaging (MRI) are increasingly used to assess ALNM noninvasively. There has been no study investigating PET/CT and MRI in direct comparative studies.
PURPOSE
To assess the diagnostic accuracy of PET/CT and MRI for ALNM in the same population of breast cancer.
STUDY TYPE
Systematic review and meta-analysis.
DATA SOURCE
PubMed-MEDLINE, Web of Science, Cochrane, EMBASE, and Chinese Biomedical Literature databases were searched (September 1993-January 2020) by using concerned keywords. Studies using both MRI and PET/CT as diagnostic methods were included. Eleven studies included 1203 breast cancer patients using PET/CT and 1186 patients using MRI.
FIELD STRENGTH
1.5T or 3.0T.
ASSESSMENT
The Quality Assessment of Diagnostic Accuracy Studies (v. 2) was used to assess the quality of the studies.
STATISTICAL TESTS
A bivariate mixed-effects binary regression model was used to obtain the diagnostic performance. Meta-regression analysis was conducted to investigate study heterogeneity.
RESULTS
A total of 369 articles were screened; out of these, 11 studies were included that meet the inclusion criteria. The respective pooled sensitivity and specificity values were 0.56 (95% confidence interval [CI]: 0.47-0.63) and 0.91 (95% CI: 0.87-0.93) for PET/CT and 0.55 (95% CI: 0.48-0.62) and 0.86 (95% CI: 0.82-0.89) for MRI. There was no statistically significant difference in sensitivity (P = 0.769) or specificity (P = 0.447) between PET/CT and MRI. There was no threshold effect in either of the imaging tests. The diagnostic performance of both imaging tests was affected by study design, breast cancer subtype, tumor stage, or imaging features.
DATA CONCLUSION
In the same population, PET/CT and MRI had comparable diagnostic performance for the detection of ALNM, with low sensitivity and high specificity.
LEVEL OF EVIDENCE
3.
TECHNICAL EFFICACY STAGE
Stage 2. J. MAGN. RESON. IMAGING 2020;52:1840-1851.
Topics: Axilla; Breast Neoplasms; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Sensitivity and Specificity
PubMed: 32567090
DOI: 10.1002/jmri.27246 -
Clinics (Sao Paulo, Brazil) 2023This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes... (Meta-Analysis)
Meta-Analysis Review
The effectiveness of ultrasound-guided core needle biopsy in detecting lymph node metastases in the axilla in patients with breast cancer: systematic review and meta-analysis.
OBJECTIVE
This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes (ALNs) region in patients with Breast Cancer (BC).
METHODS
The authors searched the electronic databases PubMed, Scopus, Embase, and Web of Science for clinical trials about US-CNB for the detection of ALNs in breast cancer patients. The authors extracted and pooled raw data from the included studies and performed statistical analyses using Meta-DiSc 1.4 and Review Manager 5.3 software. A random effects model was used to calculate the data. At the same time, data from the Ultrasound-guided Fine-Needle Aspiration (US-FNA) were introduced for comparison with the US-CNB. In addition, the subgroup was performed to explore the causes of heterogeneity. (PROSPERO ID: CRD42022369491).
RESULTS
In total, 18 articles with 2521 patients were assessed as meeting the study criteria. The overall sensitivity was 0.90 (95% CI [Confidence Interval], 0.87‒0.91; p = 0.00), the overall specificity was 0.99 (95% CI 0.98‒1.00; p = 0.62), the overall area under the curve (AUC) was 0.98. Next, in the comparison of US-CNB and US-FNA, US-CNB is better than US-FNA in the diagnosis of ALNs metastases. The sensitivity was 0.88 (95% CI 0.84‒0.91; p = 0.12) vs. 0.73 (95% CI 0.69‒0.76; p = 0.91), the specificity was 1.00 (95% CI 0.99‒1.00; p = 1.00) vs. 0.99 (95% CI 0.67‒0.74; p = 0.92), and the AUC was 0.99 vs. 0.98. Subgroup analysis showed that heterogeneity may be related to preoperative Neoadjuvant Chemotherapy (NAC) treatment, region, size of tumor diameter, and the number of punctures.
CONCLUSION
US-CNB has a satisfactory diagnostic performance with good specificity and sensitivity in the preoperative diagnosis of ALNs in BC patients.
Topics: Humans; Female; Lymphatic Metastasis; Breast Neoplasms; Biopsy, Large-Core Needle; Axilla; Sensitivity and Specificity; Lymph Nodes; Ultrasonography, Interventional; Retrospective Studies
PubMed: 37141768
DOI: 10.1016/j.clinsp.2023.100207 -
Breast Cancer (Tokyo, Japan) Jan 2022The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with...
OBJECTIVE
The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with contralateral axillary metastases (CAM) is classified as a metastatic disease. There are few cases reported and a lack of evidence of the significance of CAM when synchronous appearance with a primary tumor and no other site of disease.
METHODS
A systematic review following PRISMA guidelines to evaluate the prognosis of patients with synchronous CAM without other metastatic diseases comparing with metastatic disease is conducted through a search in PubMed, Embase, Clinical Key, and Cochrane Library databases. We present one case. The median age, follow-up, clinico-pathological characteristics, status of lymph nodes, treatments, and outcomes are analyzed.
RESULTS
A total of 23 articles (10 case reports and 13 case series) with a total 68 patients, including our case. Median age was 48 years old. Median follow-up was 27 months. Overall survival of the series was 71.4%. Twenty-one of 49 patients reported (36.2%) were alive without disease, fourteen (28.6%) were alive with disease while the rest fourteen (28.6%) died. Inflammatory presentation and ipsilateral axilla status were related to overall survival.
CONCLUSIONS
Synchronous CAM in breast cancer show better outcomes in terms of overall survival than other metastatic diseases. The absence of comparative studies may not allow definitive conclusions, meanwhile, together with other authors we suggest treatment with curative intention. More studies may lead to consider a modification of TNM system.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Prognosis
PubMed: 34652689
DOI: 10.1007/s12282-021-01293-2 -
Clinical Breast Cancer Jan 2023This is a systematic review of randomized controlled trials (RCT) comparing the use of axillary reverse mapping (ARM) with conventional technique for axillary dissection... (Review)
Review
BACKGROUND
This is a systematic review of randomized controlled trials (RCT) comparing the use of axillary reverse mapping (ARM) with conventional technique for axillary dissection (AD) in breast cancer surgery.
METHODS
This review was written in line with the PRISMA protocol. Articles were retrieved from PubMed, EMBASE, CINAHL and Cochrane databases, using keywords ..úaxillary reverse mapping..Ñ and "axillary lymph node dissection". Non-RCT were excluded. Abstracts were screened independently by 2 reviewers. Data from eligible studies were retrieved for qualitative synthesis and pooled analysis. 73 publications were identified for initial screening.
RESULTS
68 articles were excluded from analysis according to the pre-defined systematic review protocol. 5 RCTS with 1696 subjects were included for analysis. 802 patients received ARM, 894 patients received AD. Pooled ARM node detection rate was 84.9% (Range 79.2 - 94.9%). There was a lower rate of post-operative lymphedema in ARM group patients across all 5 RCTs. The pooled lymphedema incidence in the ARM group was 4.8% (37/766) when compared to 18.8% (164/873) in the AD group (P < .0001). Axillary recurrence rate with median followof 37 months was 1.03% (8/778) in the ARM group, which was identical to 1.03% (9/870) in the AD group (P = 1).
CONCLUSION
ARM resulted in decreased incidence of lymphedema. There was no significant increase in axillary recurrence at 37 months post-operation.
Topics: Humans; Female; Lymph Nodes; Breast Neoplasms; Lymph Node Excision; Lymphedema; Mastectomy; Axilla; Sentinel Lymph Node Biopsy
PubMed: 36384818
DOI: 10.1016/j.clbc.2022.10.008 -
Clinical & Translational Oncology :... Feb 2023To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and... (Review)
Review
PURPOSE
To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection.
METHODS
The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate.
RESULTS
Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11-0.17), the pooled SLNIR was 0.89 (95% CI 0.86-0.92), NPV was 0.83 (95% CI 0.79-0.87), and summary accuracy was 0.92 (95% CI 0.90-0.94). SLNB performed better when more than one node was removed and double mapping was used.
CONCLUSIONS
SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer.
Topics: Female; Humans; Breast Neoplasms; Lymph Nodes; Neoadjuvant Therapy; Axilla; Sentinel Lymph Node Biopsy; Lymph Node Excision
PubMed: 36153763
DOI: 10.1007/s12094-022-02953-1 -
Breast Cancer Research and Treatment Nov 2022Recent studies have suggested that a significant proportion of patients with axillary nodal metastases diagnosed by pre-operative axillary ultrasound (AUS)-guided needle... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent studies have suggested that a significant proportion of patients with axillary nodal metastases diagnosed by pre-operative axillary ultrasound (AUS)-guided needle biopsy were over-treated with axillary lymph node dissection (ALND). The role of routine AUS and needle biopsy in early breast cancer was questioned. This review aims to determine if pre-operative AUS could predict the extent of axillary tumor burden and need of ALND.
METHODS
PubMed and Embase literature databases were searched systematically for abnormal AUS characteristics and axillary nodal burden. Studies were eligible if they correlated the sonographic abnormalities in AUS with the resultant axillary nodal burden in ALND according to the ACOSOG Z0011 criteria.
RESULTS
Eleven retrospective studies and one prospective study with 1658 patients were included. Sixty-five percent of patients with one abnormal lymph node in AUS and 56% of those with two had low axillary nodal burden. Using one abnormal lymph node as the cut-off, the pooled sensitivity and specificity in prediction of axillary nodal burden were 66% (95%CI 63-69%) and 73% (95% CI 70-76%), respectively. Across the six studies that evaluated suspicious nodal characteristics, increased nodal cortical thickness may be associated with high axillary nodal burden.
CONCLUSION
More than half of the patients with pre-operative positive AUS and biopsy proven axillary nodal metastases were over-treated by ALND. Quantification of suspicious nodes and extent of cortical morphological changes in AUS may help identify suitable patients for sentinel lymph node biopsy.
Topics: Humans; Female; Breast Neoplasms; Tumor Burden; Retrospective Studies; Prospective Studies; Lymphatic Metastasis; Axilla; Sentinel Lymph Node Biopsy; Lymph Nodes; Lymph Node Excision
PubMed: 36138294
DOI: 10.1007/s10549-022-06699-w -
Asian Pacific Journal of Cancer... Aug 2022Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph... (Meta-Analysis)
Meta-Analysis
Comparing Early-Stage Breast Cancer Patients with Sentinel Lymph Node Metastasis with and without Completion Axillary Lymph Node Dissection: A Systematic Review and Meta-Analysis.
BACKGROUND
Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph node dissection (ALND) is used in cases with palpable axillary lymph nodes or positive SLNB cases. The aim of this review was to compare overall survival (OS), disease-free survival (DFS), and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND.
METHODS
The databases of PubMed, Scopus, and Cochrane Library were searched using the key words of "breast cancer", "axillary lymph node dissection", and "sentinel lymph node dissection". In addition, other sources were searched for ongoing studies (i.e., clinicaltrials.gov). The clinical trials were evaluated based on the Jadad quality criteria, and cohort studies were evaluated according to the STROBE criteria. At the end of the search, the articles were screened independently by two reviewers to check their eligibility to be included in the study. Afterwards, the data were extracted independently by two researchers.
RESULTS
After searching the databases, 169 papers were retrieved. However, after removing the duplicates and studying the titles and abstracts of these papers, only ten ones underwent further investigation. After reading full-text of each article, four studies were finalized. Following a manual search, 27 papers were entered into the study for the final evaluation, 11 of which were included in the meta-analysis based on the inclusion and exclusion criteria. The findings showed no significant differences in OS, DFS, and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND.
CONCLUSION
The findings did not confirm that ALND improved OS, DFS, and axillary recurrence in patients who were clinically node-negative and positive SLNB.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 36037108
DOI: 10.31557/APJCP.2022.23.8.2561 -
Breast Cancer Research and Treatment Jul 2024Evaluation of axillary lymph nodes status in cN0 axilla is performed by sentinel lymph node biopsy (SLNB) utilizing a combination of radioactive isotope and blue dye or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Evaluation of axillary lymph nodes status in cN0 axilla is performed by sentinel lymph node biopsy (SLNB) utilizing a combination of radioactive isotope and blue dye or alternative to isotope like Indocyanine green (ICG). Both are very resource-intensive; which has prompted development of low-cost technique of Fluorescein Sodium (FS)-guided SLNB. This systematic review and meta-analysis evaluate the diagnostic performance of FS-guided SLNB in early breast cancer.
OBJECTIVES
The objective was to evaluate the diagnostic performance of FS for sentinel lymph node biopsy.
METHODS
Eligibility criteria: Studies where SLNB was performed using FS.
INFORMATION SOURCES
PubMed, EMBASE, Cochrane library and online clinical trial registers. Risk of bias: Articles were assessed for risk of bias using the QUADAS-2 tool.
SYNTHESIS OF RESULTS
The main summary measures were pooled Sentinel Lymph Node Identification Rate (SLN-IR) and pooled False Negative Rate (FNR) using random-effects model.
RESULTS
A total of 45 articles were retrieved by the initial systematic search. 7 out of the 45 studies comprising a total of 332 patients were included in the meta-analysis. The pooled SLN-IR was 93.2% (95% confidence interval [CI], 0.87-0.97; 87% to 97%). Five validation studies were included for pooling the false negative rate and included a total of 211 patients. The pooled FNR was 5.6% (95% confidence interval [CI], 2.9-9.07).
CONCLUSION
Fluorescein-guided SLNB is a viable option for detection of lymph node metastases in clinically node negative patients with early breast cancer. It achieves a high pooled Sentinel Lymph Node Identification Rate (SLN-IR) of 93% with a false negative rate of 5.6% for the detection of axillary lymph node metastasis.
Topics: Humans; Sentinel Lymph Node Biopsy; Breast Neoplasms; Female; Fluorescein; Lymphatic Metastasis; Sentinel Lymph Node; Axilla; Image-Guided Biopsy
PubMed: 38668856
DOI: 10.1007/s10549-024-07310-0