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Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis

BACKGROUND: Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sent...

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Autores principales: Davey, Matthew G., O’Flaherty, Colm, Cleere, Eoin F., Nohilly, Aoife, Phelan, James, Ronane, Evan, Lowery, Aoife J., Kerin, Michael J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982203/
https://www.ncbi.nlm.nih.gov/pubmed/35380620
http://dx.doi.org/10.1093/bjsopen/zrac022
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author Davey, Matthew G.
O’Flaherty, Colm
Cleere, Eoin F.
Nohilly, Aoife
Phelan, James
Ronane, Evan
Lowery, Aoife J.
Kerin, Michael J.
author_facet Davey, Matthew G.
O’Flaherty, Colm
Cleere, Eoin F.
Nohilly, Aoife
Phelan, James
Ronane, Evan
Lowery, Aoife J.
Kerin, Michael J.
author_sort Davey, Matthew G.
collection PubMed
description BACKGROUND: Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sentinel lymph node biopsy (SLNB). Quantification of the necessity of upfront SLNB for DCIS requires investigation. The aim was to establish the likelihood of having a positive SLNB (SLNB+) for DCIS and to establish parameters predictive of SLNB+. METHODS: A systematic review was performed as per the PRISMA guidelines. Prospective studies only were included. Characteristics predictive of SLNB+ were expressed as dichotomous variables and pooled as odds ratios (o.r.) and associated 95 per cent confidence intervals (c.i.) using the Mantel–Haenszel method. RESULTS: Overall, 16 studies including 4388 patients were included (mean patient age 54.8 (range 24 to 92) years). Of these, 72.5 per cent of patients underwent SLNB (3156 of 4356 patients) and 4.9 per cent had SLNB+ (153 of 3153 patients). The likelihood of having SLNB+ for DCIS was less than 1 per cent (o.r. <0.01, 95 per cent c.i. 0.00 to 0.01; P < 0.001, I(2) = 93 per cent). Palpable DCIS (o.r. 2.01, 95 per cent c.i. 0.64 to 6.24; P = 0.230, I(2) = 0 per cent), tumour necrosis (o.r. 3.84, 95 per cent c.i. 0.85 to 17.44; P = 0.080, I(2) = 83 per cent), and grade 3 DCIS (o.r. 1.34, 95 per cent c.i. 0.80 to 2.23; P = 0.270, I(2) = 0 per cent) all trended towards significance in predicting SLNB+. CONCLUSION: While aggressive clinicopathological parameters may guide SLNB for patients with DCIS, the absolute and relative risk of SLNB+ for DCIS is less than 5 per cent and 1 per cent, respectively. Well-designed randomized controlled trials are required to establish fully the necessity of SLNB for patients diagnosed with DCIS. REGISTRATION NUMBER: CRD42021284194 (https://www.crd.york.ac.uk/prospero/)
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spelling pubmed-89822032022-04-05 Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis Davey, Matthew G. O’Flaherty, Colm Cleere, Eoin F. Nohilly, Aoife Phelan, James Ronane, Evan Lowery, Aoife J. Kerin, Michael J. BJS Open Systematic Review BACKGROUND: Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sentinel lymph node biopsy (SLNB). Quantification of the necessity of upfront SLNB for DCIS requires investigation. The aim was to establish the likelihood of having a positive SLNB (SLNB+) for DCIS and to establish parameters predictive of SLNB+. METHODS: A systematic review was performed as per the PRISMA guidelines. Prospective studies only were included. Characteristics predictive of SLNB+ were expressed as dichotomous variables and pooled as odds ratios (o.r.) and associated 95 per cent confidence intervals (c.i.) using the Mantel–Haenszel method. RESULTS: Overall, 16 studies including 4388 patients were included (mean patient age 54.8 (range 24 to 92) years). Of these, 72.5 per cent of patients underwent SLNB (3156 of 4356 patients) and 4.9 per cent had SLNB+ (153 of 3153 patients). The likelihood of having SLNB+ for DCIS was less than 1 per cent (o.r. <0.01, 95 per cent c.i. 0.00 to 0.01; P < 0.001, I(2) = 93 per cent). Palpable DCIS (o.r. 2.01, 95 per cent c.i. 0.64 to 6.24; P = 0.230, I(2) = 0 per cent), tumour necrosis (o.r. 3.84, 95 per cent c.i. 0.85 to 17.44; P = 0.080, I(2) = 83 per cent), and grade 3 DCIS (o.r. 1.34, 95 per cent c.i. 0.80 to 2.23; P = 0.270, I(2) = 0 per cent) all trended towards significance in predicting SLNB+. CONCLUSION: While aggressive clinicopathological parameters may guide SLNB for patients with DCIS, the absolute and relative risk of SLNB+ for DCIS is less than 5 per cent and 1 per cent, respectively. Well-designed randomized controlled trials are required to establish fully the necessity of SLNB for patients diagnosed with DCIS. REGISTRATION NUMBER: CRD42021284194 (https://www.crd.york.ac.uk/prospero/) Oxford University Press 2022-04-05 /pmc/articles/PMC8982203/ /pubmed/35380620 http://dx.doi.org/10.1093/bjsopen/zrac022 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Systematic Review
Davey, Matthew G.
O’Flaherty, Colm
Cleere, Eoin F.
Nohilly, Aoife
Phelan, James
Ronane, Evan
Lowery, Aoife J.
Kerin, Michael J.
Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
title Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
title_full Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
title_fullStr Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
title_full_unstemmed Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
title_short Sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
title_sort sentinel lymph node biopsy in patients with ductal carcinoma in situ: systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8982203/
https://www.ncbi.nlm.nih.gov/pubmed/35380620
http://dx.doi.org/10.1093/bjsopen/zrac022
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