META-ANALYSIS OF SENTINEL LYMPH NODE BIOPSY (SLNB) VS. AXILLARY LYMPH NODE DISSECTION (ALND) IN BREAST CANCER SURGERY
Main Article Content
Keywords
SLNB, ALND, Breast cancer, Oncological outcomes, Postoperative complication, Quality of life, Meta-synthesis.
Abstract
Different types of surgery for breast cancer treatment include sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND). This meta-analysis aims to analyze the oncological effect, complications, and quality of life after the two surgeries. A systematic search for clinical trials, cohort studies, and propensity score matching analysis was conducted using the major electronic databases. Altogether, the authors of 12 studies, including 6450 patients, evaluated the results. With clinically negative axillae, SLNB was as effective as ALND in terms of disease-free survival and overall survival in early breast cancer. It was associated with substantially lower rates of postoperative morbidity, such as lymphedema, pain, and shoulder dysfunction, compared to ALND. For patients with minimal nodal burden, SLNB followed by systemic therapy appropriate to the primary tumor was not inferior to ALND for regional control; however, ALND remained crucial for patients with extensive disease in the axilla. The results highlighted the benefits of SLNB in relation to its impact on the quality of life of patients without impacting the oncological outcome in appropriate patient populations to support the utilization of SLNB. Nevertheless, the benefits of SLNB are apparent, and further work is needed to narrow the criteria that would qualify a patient for the surgery and to apply SLNB in an individualized approach.
References
2. Alemany, M., Velasco, R., Simó, M., & Bruna, J. (2021). Late effects of cancer treatment: consequences for long-term brain cancer survivors. Neuro-Oncology Practice, 8(1), 18-30.
3. Aron, A., & Zavaleta, C. (2024). Current and developing lymphatic imaging approaches for elucidation of functional mechanisms and disease progression. Molecular Imaging and Biology, 26(1), 1-16.
4. Belmonte Martinez, R., Messaggi-Sartor, M., Ferrer Forés, M. M., Pont Acuña, À., & Escalada, F. (2018). Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB.
5. Bochtler, T., Löffler, H., & Krämer, A. (2018, May). Diagnosis and management of metastatic neoplasms with unknown primary. In Seminars in diagnostic pathology (Vol. 35, No. 3, pp. 199-206). WB Saunders.
6. Burguin, A., Diorio, C., & Durocher, F. (2021). Breast cancer treatments: updates and new challenges. Journal of personalized medicine, 11(8), 808.
7. Cantini, L., Trapani, D., Guidi, L., Bielo, L. B., Scafetta, R., Koziej, M., ... & Curigliano, G. (2023). Neoadjuvant therapy in hormone Receptor-Positive/HER2-Negative breast cancer. Cancer Treatment Reviews, 102669.
8. Casarin, J. (2023). Reassessing the Significance of Tumor Diameter and Surgical Approach in Predicting Recurrence of Early-Stage Cervical Cancer.
9. Che Bakri, N. A., Kwasnicki, R. M., Dhillon, K., Khan, N., Ghandour, O., Cairns, A., ... & Leff, D. R. (2021). Objective assessment of postoperative morbidity after breast cancer treatments with wearable activity monitors: the "BRACELET" study. Annals of Surgical Oncology, 28, 5597-5609.
10. Cserni, G., Maguire, A., Bianchi, S., Ryska, A., & Kovács, A. (2022). Sentinel lymph node assessment in breast cancer—an update on current recommendations. Virchows Archiv, 480(1), 95-107.
11. Dalal, H. (2024). Precision Medicine in Breast Cancer: A Molecular Genomics and Diagnostics Approach.
12. Daly, G. R., Dowling, G. P., Said, M., Qasem, Y., Hembrecht, S., Calpin, G. G., ... & Hill, A. D. (2024). Impact of sentinel lymph node biopsy on management of older women with clinically node-negative, early-stage, ER+/HER2-, invasive breast cancer: a systematic review and meta-analysis. Clinical Breast Cancer.
13. Dixon, J. M., & Cartlidge, C. W. (2020). Twenty‐five years of change in the management of the axilla in breast cancer. The Breast Journal, 26(1), 22-26.
14. Dominici, L., Hu, J., Zheng, Y., Kim, H. J., King, T. A., Ruddy, K. J., ... & Rosenberg, S. M. (2021). Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA surgery, 156(10), e213758-e213758.
15. Fan, M. S., Qiu, K. X., Wang, D. Y., Wang, H., Zhang, W. W., & Yan, L. (2024). Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis. Frontiers in Oncology, 14, 1391267.
16. Gariboldi, E. M., Ubiali, A., Chiti, L. E., Ferrari, R., De Zani, D., Zani, D. D., ... & Auletta, L. (2023). Evaluation of surgical aid of methylene blue in addition to intraoperative gamma probe for sentinel lymph node extirpation in 116 canine mast cell tumors (2017–2022). Animals, 13(11), 1854.
17. Gibert-Ramos, A., López, C., Bosch, R., Fontoura, L., Bueno, G., García-Rojo, M., ... & Lejeune, M. (2019). Immune response profile of primary tumour, sentinel and non-sentinel axillary lymph nodes related to metastasis in breast cancer: an immunohistochemical point of view. Histochemistry and Cell Biology, 152(3), 177-193.
18. Giffoni de Mello Morais Mata, D., Chehade, R., Hannouf, M. B., Raphael, J., Blanchette, P., Al-Humiqani, A., & Ray, M. (2023). Appraisal of Systemic Treatment Strategies in Early HER2-Positive Breast Cancer—A Literature Review. Cancers, 15(17), 4336.
19. Golshan, M., Loibl, S., Wong, S. M., Huober, J. B., O'Shaughnessy, J., Rugo, H. S., ... & Untch, M. (2020). Breast conservation after neoadjuvant chemotherapy for triple-negative breast cancer: surgical results from the BrighTNess randomized clinical trial. JAMA surgery, 155(3), e195410-e195410.
20. Gradishar, W. J., Moran, M. S., Abraham, J., Aft, R., Agnese, D., Allison, K. H., ... & Kumar, R. (2022). Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 20(6), 691-722.
21. Gripsrud, B. H., Ramvi, E., & Ribers, B. (2020). Couldn't care less? A psychosocial analysis of contemporary cancer care policy as a case of borderline welfare. Journal of Psychosocial Studies, 13(3), 247-262.
22. Koirala, N. (2018). Assessment of the Efficacy of Sentinel Lymph Node Biopsy in Detecting Axillary Metastases in Node Negative Breast Cancer Using Blue Dye Only, in a Tertiary Care Hospital (Master's thesis, Rajiv Gandhi University of Health Sciences (India)).
23. Kuru, B. (2020). The adventure of axillary treatment in early stage breast cancer. European Journal of Breast Health, 16(1), 1.
24. Li, X., Wang, L., Wang, Y., Ma, L., Zheng, R., Ding, J., ... & Zha, X. (2024). Omission of sentinel lymph node biopsy in patients with clinically axillary lymph node-negative early breast cancer (OMSLNB): protocol for a prospective, non-inferiority, single-arm, phase II clinical trial in China. BMJ open, 14(9), e087700.
25. Litterini, A. J., & Wilson, C. M. (2021). Management of Conditions and Symptoms. In Physical Activity and Rehabilitation in Life-threatening Illness (pp. 211-248). Routledge.
26. Luthans, F., Luthans, B. C., & Luthans, K. W. (2021). Organizational behavior: An evidence-based approach fourteenth edition. IAP.
27. Madekivi, V., Boström, P., Karlsson, A., Aaltonen, R., & Salminen, E. (2020). Can a machine-learning model improve the prediction of nodal stage after a positive sentinel lymph node biopsy in breast cancer?. Acta Oncologica, 59(6), 689-695.
28. Makovski, T. T., Schmitz, S., Zeegers, M. P., Stranges, S., & van den Akker, M. (2019). Multimorbidity and quality of life: systematic literature review and meta-analysis. Ageing research reviews, 53, 100903.
29. Małkiewicz, B., Kiełb, P., Kobylański, M., Karwacki, J., Poterek, A., Krajewski, W., ... & Szydełko, T. (2023). Sentinel lymph node techniques in urologic oncology: current knowledge and application. Cancers, 15(9), 2495.
30. Mathelin, C., & Lodi, M. (2021). Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions. Chinese clinical oncology, 10(2).
31. McEvoy, M. P., Ravetch, E., Patel, G., Fox, J., & Feldman, S. (2021). Prevention of breast cancer-related lymphedema. Clinical breast cancer, 21(2), 128-142.
32. Mirzaei, N. (2024). Superparamagnetic iron oxide for sentinel lymph node biopsy.
33. Mokhatri-Hesari, P., & Montazeri, A. (2020). Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health and quality of life outcomes, 18, 1-25.
34. Onya, A. I. (2023). Postoperative pain management after mastectomy.
35. Ostapenko, E. (2024). Immediate prepectoral implant-based breast reconstruction for breast cancer patients (Doctoral dissertation, Vilniaus universitetas.).
36. Pesapane, F., Mariano, L., Magnoni, F., Rotili, A., Pupo, D., Nicosia, L., ... & Cassano, E. (2023). Future Directions in the Assessment of Axillary Lymph Nodes in Patients with Breast Cancer. Medicina, 59(9), 1544.
37. Rodrick, J., Barnhart, H., Rockson, S. G., & Maldonado, T. (2024). Evaluation of a Novel Wearable Non-Pneumatic Compression Device for the Treatment of Breast Cancer-Related Lymphedema. Biomedical Materials & Devices, 1-7.
38. Rudolph, C. W., Chang, C. K., Rauvola, R. S., & Zacher, H. (2020). Meta-analysis in vocational behavior: A systematic review and recommendations for best practices. Journal of Vocational Behavior, 118, 103397.
39. Simons, J. M., van Nijnatten, T. J., van der Pol, C. C., Luiten, E. J., Koppert, L. B., & Smidt, M. L. (2019). Diagnostic accuracy of different surgical procedures for axillary staging after neoadjuvant systemic therapy in node-positive breast cancer: a systematic review and meta-analysis. Annals of surgery, 269(3), 432-442.
40. Small Jr, W., & Thomas, T. O. (Eds.). (2019). Intraoperative Radiotherapy (IORT)–A New Frontier for Personalized Medicine as Adjuvant Treatment and Treatment of Locally Recurrent Advanced Malignancy. Frontiers Media SA.
41. Theile, h. (2021). Sentinel lymph node biopsy for high risk thin (t1b) melanoma: the queensland experience over 16 years. Anz j. Surg, 91(S1), 60-99.
42. Tourani, s. (2021). Axillary reverse mapping in axillary lymph node dissection for breast cancer; a systematic review. Anz j. Surg, 91(S1), 8-21.
43. Van Laar, R., Latif, B., King, S., Love, C., Taubenheim, N., Kalansooriya, E., ... & Landgren, T. (2023). Validation of a microRNA liquid biopsy assay for diagnosis and risk stratification of invasive cutaneous melanoma. British Journal of Dermatology, 189(3), 292-301.
44. Voiculescu, Ş. (2021). Long-Term Complications and Management. Breast Cancer Essentials: Perspectives for Surgeons, 599-614.
45. Waks, A. G., & Winer, E. P. (2019). Breast cancer treatment: a review. Jama, 321(3), 288-300.
46. Xie, X., Tan, W., Chen, B., Huang, X., Peng, C., Yan, S., ... & Xie, X. (2018). Preoperative prediction nomogram based on primary tumor miRNAs signature and clinical‐related features for axillary lymph node metastasis in early‐stage invasive breast cancer. International journal of cancer, 142(9), 1901-1910.
47. Xu, Z. Y., Li, Z. Z., Cao, L. M., Zhong, N. N., Liu, X. H., Wang, G. R., ... & Bu, L. L. (2024). Seizing the fate of lymph nodes in immunotherapy: To preserve or not?. Cancer Letters, 216740.
48. Xue, L., Williamson, A., Gaines, S., Andolfi, C., Paul-Olson, T., Neerukonda, A., ... & Hyman, N. (2018). An update on colorectal cancer. Current problems in surgery, 55(3), 76-116.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Roda Rashid Bin Sultan Alshamsi
University of Sharjah, College of Medicine, Email id: Rouhda.alshamsi@gmail.com, Orchid id: https://orcid.org/0009-0005-0328-4891
Meera Ahmed Mohamed Othman Ali
University of Sharjah, College of Medicine, Email id: Meera.ahmed.90@gmail.com, Orchid id: https://orcid.org/0009-0001-0162-4232
Nabaa shakir mahmood
University of Sharjah, College of Medicine, Email id: shakernabaa1@gmail.com, Orchid id: https://orcid.org/0009-0002-8960-5542
Gana Ali Ahmad Tahmaz
University of sharjah, College of Medicine, Email id: U19102238@sharjah.ac.ae, Orchid id: https://orcid.org/0009-0003-1705-6705
Sara Ahmed Al Amoodi
Gulf medical university, College of Medicine, Email id: Sa2014946@icloud.com, Orchid id: https://orcid.org/0009-0002-7972-4521
Hind Tariq Alzarooni
University of Sharjah, College of Medicine, Email id: Hindalzarooni.26@gmail.com, Orchid id: https://orcid.org/0009-0009-4712-694X
Meera Mohamed Al Yazeedi
Ilia State University, College of Medicine, Email id: Meeramhkb@gmail.com, Orchid id: https://orcid.org/0009-0005-6814-8380
Mahra Salem Mubarak Albreiki
University of Sharjah, College of Medicine, Email id: M.04.albreiki@gmail.com, Orchid id: https://orcid.org/0009-0006-3449-3474
Reem Sultan BinTarish Al Mheiri
University of Sharjah, College of Medicine, Email id: Reembintarish@gmail.com, Orchid id: https://orcid.org/0009-0007-5500-4622
Hana Abdelnaser Skheta
University of Sharjah, College of Medicine, Email id: Drhanask@gmail.com, Orchid id: https://orcid.org/0009-0008-9292-0045