-
Annals of Surgical Oncology Jan 2014This meta-analysis was designed to evaluate the utility of preoperative axillary ultrasound combined with US-guided lymph node biopsy if indicated (AUS ± biopsy), in... (Meta-Analysis)
Meta-Analysis Review
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.
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.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Preoperative Care; Prognosis; Sentinel Lymph Node Biopsy; Ultrasonography, Interventional
PubMed: 24008555
DOI: 10.1245/s10434-013-3229-6 -
Annals of Surgical Oncology Mar 2024Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify techniques to prevent seroma formation. The aim of this systematic review and network meta-analysis is to use available literature to identify the best intervention for prevention of seroma after standalone ALND.
METHODS
A literature search was performed for all comparative articles regarding seroma formation in patients undergoing a standalone ALND or ALND with breast-conserving surgery in the last 25 years. Data regarding seroma formation, clinically significant seroma (CSS), surgical site infections (SSI), and hematomas were collected. The network meta-analysis was performed using a random effects model and the level of inconsistency was evaluated using the Bucher method.
RESULTS
A total of 19 articles with 1962 patients were included. Ten different techniques to prevent seroma formation were described. When combining direct and indirect comparisons, axillary drainage until output is less than 50 ml per 24 h for two consecutive days results in significantly less CSS. The use of energy sealing devices, padding, tissue glue, or patches did not significantly reduce the incidence of CSS. When comparing the different techniques with regard to SSIs, no statistically significant differences were seen.
CONCLUSIONS
To prevent CSS after ALND, axillary drainage is the most valuable and scientifically proven measure. On the basis of the results of this systematic review with network meta-analysis, removing the drain when output is < 50 ml per 24 h for two consecutive days irrespective of duration seems best. Since drainage policies vary widely, an evidence-based guideline is needed.
Topics: Humans; Female; Seroma; Lymph Node Excision; Mastectomy, Segmental; Drainage; Disease Progression; Axilla; Surgeons; Breast Neoplasms
PubMed: 38038792
DOI: 10.1245/s10434-023-14631-9 -
Supportive Care in Cancer : Official... Dec 2022To review and update the incidence and risk factors for breast cancer-related lymphedema based on cohort studies. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To review and update the incidence and risk factors for breast cancer-related lymphedema based on cohort studies.
METHODS
The study was guided by the Joanna Briggs Institute methodology and the Cochrane handbook for systematic reviews. PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, CNKI, SinoMed, and Wan Fang Database were searched from inception to November 15, 2021. Cohort studies reported adjusted risk factors were selected. PRISMA guideline was followed. Study quality were evaluated using the Newcastle-Ottawa scale. Random-effects models were adopted. The robustness of pooled estimates was validated by meta-regression and subgroup analysis. Lymphedema incidence and adjusted risk factors in the multivariable analyses with hazard / odds ratios and 95% CIs were recorded.
RESULTS
Eighty-four cohort studies involving 58,358 breast cancer patients were included. The pooled incidence of lymphedema was 21.9% (95% CI, 19.8-24.0%). Fourteen factors were identified including ethnicity (black vs. white), higher body mass index, higher weight increase, hypertension, higher cancer stage (III vs. I-II), larger tumor size, mastectomy (vs. breast conservation surgery), axillary lymph nodes dissection, more lymph nodes dissected, higher level of lymph nodes dissection, chemotherapy, radiotherapy, surgery complications, and higher relative volume increase postoperatively. Additionally, breast reconstruction surgery, and adequate finance were found to play a protective role. However, other variables such as age, number of positive lymph nodes, and exercise were not correlated with risk of lymphedema.
CONCLUSION
Treatment-related factors still leading the development of breast cancer-related lymphedema. Other factors such as postoperative weight increase and finance status also play a part. Our findings suggest the need to shift the focus from treatment-related factors to modifiable psycho-social-behavioral factors.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Axilla; Unilateral Breast Neoplasms; Breast Cancer Lymphedema; Lymphedema; Lymph Node Excision; Risk Factors; Cohort Studies
PubMed: 36513801
DOI: 10.1007/s00520-022-07508-2 -
Academic Radiology May 2009Breast cancer is the leading cause of mortality in women worldwide. Lymphatic mapping with sentinel node biopsy has the potential to reduce the morbidity associated with... (Meta-Analysis)
Meta-Analysis Review
RATIONALE AND OBJECTIVES
Breast cancer is the leading cause of mortality in women worldwide. Lymphatic mapping with sentinel node biopsy has the potential to reduce the morbidity associated with breast cancer staging in women after neoadjuvant therapy.
MATERIALS AND METHODS
A systematic search of world literature between 1996 and 2007 of sentinel node mapping in patients with early-stage breast carcinoma after chemotherapy was undertaken. Potentially eligible studies were identified using database-specific search strategies incorporating appropriate Boolean combinations of the keywords sentinel node biopsy or sentinel node localization or lymphatic mapping; breast cancer or malignancy or neoplasm; and preoperative or neoadjuvant chemotherapy. The electronic searches were augmented with a manual search of reference lists from identified articles. Successful lymph node mapping, defined as successful identification rate (SIR), and false-negative rate (FNR) was summarized using a bivariate random effects mixed model. The extent of heterogeneity was assessed using the inconsistency statistic. The effect of study level covariates, such as use of immunohistochemistry or dual mapping technique, and individual quality criteria, such as study design or multi-institution participation, on SIR and FNR were analyzed using metaregression.
RESULTS
A total of 24 trials of 1799 subjects were reported that met eligibility criteria. All studies identified were published between 2000 and 2007. Lymph node involvement was found in 758 patients (37%) and ranged from 25% to 96% across studies. The proportion of patients who had successful lymph node mapping ranged from 63% to 100%, with 79% of studies reporting a rate of less than 95%. The summary successful identification rate was 0.896 (95% confidence interval [CI] 0.860-0.923) with moderate heterogeneity. The summary FNR was 0.084 (95% CI 0.064-0.109) with no significant heterogeneity. Increasing prevalence of lymph node involvement and same-day mapping and lymph node dissection both significantly reduced the FNR.
CONCLUSIONS
The present systematic review demonstrates robust estimates of successful identification rate and false-negative rates of sentinel lymph node mapping and biopsy after neoadjuvant therapy for early-stage breast cancer patients. With a 90% SIR and 8% FNR, this technique is a reliable tool for planning treatment in this population as an alternative to completion axillary lymph node dissection.
Topics: Antineoplastic Agents; Breast Neoplasms; Female; Humans; Incidence; Lymphatic Metastasis; Neoadjuvant Therapy; Sentinel Lymph Node Biopsy
PubMed: 19345896
DOI: 10.1016/j.acra.2009.01.026 -
Breast Cancer Research and Treatment Apr 2017New indications have been found for regional nodal irradiation (RNI) in breast cancer treatment, yet the relationship of RNI and lymphedema risk is uncertain. We sought... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
New indications have been found for regional nodal irradiation (RNI) in breast cancer treatment, yet the relationship of RNI and lymphedema risk is uncertain. We sought to determine the association of RNI and lymphedema.
METHODS
We searched MEDLINE, EMBASE, and Scopus for articles in English on humans published from 1995 to 2015, using search terms breast neoplasm, treatment, and morbidity. Two investigators independently selected articles and extracted information, including manuscripts reporting incidence of lymphedema by radiation targets. Meta-analyses, review papers, case-control studies, matched-pair studies, repetitive datasets, and retrospective studies were excluded. A total of 2399 abstracts were identified and 323 corresponding articles reviewed. Twenty-one studies met inclusion criteria. Data were pooled using a random effects mixed model. Network meta-analyses were performed to determine the association of radiation targets alone and radiation targets plus extent of axillary surgery on incidence of lymphedema.
RESULTS
The addition of RNI to breast/CW irradiation was associated with an increased incidence of lymphedema (OR 2.85; 95% CI 1.24-6.55). In patients treated with sentinel lymph node biopsy or axillary sampling, there was no association of lymphedema with the addition of RNI to breast/CW irradiation (OR 1.58; 95% CI 0.54-4.66; pooled incidence 5.7 and 4.1%, respectively). Among patients treated with axillary lymph node dissection (ALND), treatment with RNI in addition to breast/CW radiation was associated with a significantly higher risk of lymphedema (OR 2.74; 95% CI 1.38-5.44; pooled incidence 18.2 and 9.4%, respectively).
CONCLUSIONS
RNI is associated with a significantly higher risk of lymphedema than irradiation of the breast/CW, particularly after ALND.
Topics: Axilla; Breast Neoplasms; Female; Humans; Incidence; Lymph Node Excision; Lymph Nodes; Lymphedema; Odds Ratio; Risk; Sentinel Lymph Node Biopsy
PubMed: 28012086
DOI: 10.1007/s10549-016-4089-0 -
Breast Cancer Research and Treatment Feb 2014The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and... (Review)
Review
The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and time course of these impairments. A systematic literature search was performed using different electronic databases until October 2013. Inclusion criteria were (1) research studies that included breast cancer patients surgically treated using the sentinel lymph node biopsy (SLNB) technique, (2) sentinel node-negative patients, and (3) studies that investigated morbidities of shoulder and/or arm. The exclusion criteria were (1) reviews or case studies, (2) patients who have had a SLNB followed by an axillary lymph node dissection (ALND), (3) results of ALND patients and SLNB patients were not described separately, and (4) no follow-up described. Thirty articles were included, representing 5,448 patients. Shoulder and arm impairments among sentinel node-negative patients are loss of mobility, loss of strength, pain, axillary web syndrome, and sensory disorders. Within the first month after SLNB, the morbidities with the highest incidence are decreased abduction (range 40.8-100 %), forward flexion of the shoulder (range 37-100 %), pain (range 3.4-56.6 %), and numbness (range 2-64 %). Morbidities with the highest incidence after 2 years are pain (range 5.6-51.1 %), numbness (range 5.1-51.1 %), loss of strength (range 0-57.7 %), decreased internal rotation (44.4 %), and decreased abduction (range 0-41.4 %). In conclusion, although the shoulder and arm impairments are less common after SLNB alone compared to ALND, they cannot be neglected. A considerable amount of patients still suffer from those impairments more than 2 years after surgery.
Topics: Arm; Breast Neoplasms; Female; Humans; Morbidity; Sentinel Lymph Node Biopsy; Shoulder
PubMed: 24496928
DOI: 10.1007/s10549-014-2846-5 -
Breast (Edinburgh, Scotland) Jun 2009To assess the feasibility, effectiveness and morbidity associated with Endoscopic Axillary Dissection. (Review)
Review
OBJECTIVES
To assess the feasibility, effectiveness and morbidity associated with Endoscopic Axillary Dissection.
METHODS
All studies published from 1990 until December 2008 in MEDLINE, LILACS, and COCHRANE. These studies were selected by two levels of criteria. Methodological designs, operating parameters, and postoperative follow-up were selected from each publication.
RESULTS
We extracted 49 citations and 12 were analyzed. The average age was 54.95+/-5.84 years. The surgical time was longer than the open procedure. The average number of extracted nodes exceeded ten. Technical problems and intra-operative complications had a rare occurrence. The recurrence was 0.5% (4/752). Two port metastases were registered. The methodological quality score average was 14.75.
CONCLUSIONS
This procedure meets the tumor control and staging requirements. It has shown similar results to the traditional procedure in terms of patient recovery, although the available evidence is not methodologically appropriate and does not justify its oncological safety.
Topics: Aged; Axilla; Breast Neoplasms; Clinical Trials as Topic; Endoscopy; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymph Nodes; Middle Aged; Postoperative Complications; Women's Health
PubMed: 19493679
DOI: 10.1016/j.breast.2009.05.001 -
Breast Cancer (Tokyo, Japan) Nov 2021This meta-analysis was designed to assess the association between two loco-regional therapies, regional nodal irradiation (RNI) and axillary lymph node dissection... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis was designed to assess the association between two loco-regional therapies, regional nodal irradiation (RNI) and axillary lymph node dissection (ALND), and breast cancer-related lymphoedema (BCRL).
METHODS
We searched PubMed, Science Direct, Embase, and BMJ databases for clinical studies published between January 1, 2010 and January 1, 2020, which assessed risk factors and incidence/prevalence of BCRL. Two investigators independently selected articles to extract relative data and calculate corresponding exact binomial 95% confidence intervals (CIs). In total, 93 articles were reviewed, from which 19 studies were selected. The extracted data were pooled using a random-effects mixed model.
RESULTS
The incidence of lymphedema in the selected studies ranged from 3% to 36.7%, with a pooled incidence of 14.29% (95% CI 13.79-14.79). The summary odds ratio/risk ratio (OR/RR) of ALND vs. no-ALND was 3.67 (95% CI 2.25-5.98) with a heterogeneity (I) of 81% (P < 0.00001). After excluding the studies with an abnormally high risk of lymphedema from self-reporting, the summary hazard ratio (HR) was 2.99 (95% CI 2.44-3.66) with no heterogeneity (I = 0%, P = 0.83). The summary OR/RR of patients with vs. without radiotherapy (RT) was 1.82 (95% CI 0.92-3.59), but the RR of RT to breast/chest vs. both axillary and supraclavicular areas was 2.66 (95% CI 0.73-9.70).
CONCLUSION
Regional nodal irradiation has a significantly higher risk for developing lymphedema than irradiation of the breast/chest wall. Axillary dissection and axillary RT have a similar risk for early-onset of breast cancer-related lymphoedema, although the risk trends higher for axillary dissection.
Topics: Breast Neoplasms; Female; Humans; Incidence; Lymph Node Excision; Lymphatic Metastasis; Lymphedema; Risk Assessment; Risk Factors; Sentinel Lymph Node Biopsy
PubMed: 34106427
DOI: 10.1007/s12282-021-01263-8 -
World Journal of Surgical Oncology Apr 2024The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023.
MATERIALS AND METHODS
The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google.
RESULTS
We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I = 44.3% (95% CI 8.9%-65.9%), Q = 39.48, p = .012. When disaggregated by evaluation type, the difference in PPEs between evaluation types was negligible. For cadaveric dissection, the PPE was 99.7% (95% CI 99.1%-100.0%) compared to 99.0% (95% CI 98.1%-99.7%).
CONCLUSIONS
The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
Topics: Humans; Female; Melanoma; Intercostal Nerves; Lymph Node Excision; Sentinel Lymph Node Biopsy; Breast Neoplasms; Axilla; Cadaver
PubMed: 38605346
DOI: 10.1186/s12957-024-03374-w -
European Journal of Surgical Oncology :... May 2007To review the established and emerging techniques in axillary lymph node prediction and explore their potential impact on clinical practice. To reliably identify... (Review)
Review
AIMS
To review the established and emerging techniques in axillary lymph node prediction and explore their potential impact on clinical practice. To reliably identify patients in whom axillary lymph node surgery, including SLNB, can be safely omitted.
METHODS
Searches of PubMed were made using the search terms "axilla" (or "axillary"), "lymph", "node" and "predictor" (or "prediction"). Articles from abstracts and reports from meetings were included only when they related directly to previously published work.
FINDINGS
There are numerous studies in which the predictive utility of biomarkers as determinants of axillary lymph node status have been investigated. Few of these have specifically addressed the attributes of the primary tumour which could offer much potential for the prediction of tumour metastasis to the axillary lymph nodes.
CONCLUSIONS
Currently, no single marker is sufficiently accurate to obviate the need for formal axillary staging using SLNB or axillary clearance.
Topics: Axilla; Biomarkers, Tumor; Breast Neoplasms; Female; Genetic Markers; Humans; Lymph Node Excision; Lymphatic Metastasis; Neoplasm Staging; Predictive Value of Tests; Prognosis; Risk Factors; Sentinel Lymph Node Biopsy
PubMed: 17125963
DOI: 10.1016/j.ejso.2006.09.003