AUTHOR=Li Changzai , Zhang Pan , Lv Jie , Dong Wei , Hu Baoshan , Zhang Jinji , Zhu Hongcheng 

TITLE=Axillary management in patients with clinical node-negative early breast cancer and positive sentinel lymph node: a systematic review and meta-analysis

JOURNAL=Frontiers in Oncology

VOLUME=13

YEAR=2024

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1320867

DOI=10.3389/fonc.2023.1320867

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>The omission of axillary lymph node dissection (ALND) or axillary radiation (AxRT) remains controversial in patients with clinical node-negative early breast cancer and a positive sentinel lymph node.</p></sec><sec><title>Methods</title><p>We conducted a comprehensive review by searching PubMed, Embase, Web of Science, and Cochrane databases (up to November 2023). Our primary outcomes were overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and axillary recurrence (AR).</p></sec><sec><title>Results</title><p>We included 26 studies encompassing 145,548 women with clinical node-negative early breast cancer and positive sentinel lymph node. Pooled data revealed no significant differences between ALND and sentinel lymph node biopsy (SLNB) alone in terms of OS (hazard ratio [HR]0.99, 95% confidence interval [CI] 0.91-1.08, <italic>p</italic>=0.84), DFS (HR 1.04, 95% CI 0.90-1.19, <italic>p</italic>=0.61), LRR (HR 0.76, 95% CI 0.45-1.20, <italic>p</italic>=0.31), and AR (HR 1.01, 95% CI 0.99-1.03, <italic>p</italic>=0.35). Similarly, no significant differences were observed between AxRT and SLNB alone for OS (HR 0.57, 95% CI 0.32-1.02, <italic>p</italic>=0.06) and DFS (HR 0.52, 95% CI 0.26-1.05, <italic>p</italic>=0.07). When comparing AxRT and ALND, a trend towards higher OS was observed the AxRT group (HR 0.08, 95% CI 0.67-1.15), but the difference did not reach statistical significance (<italic>p</italic>=0.35, I<sup>2</sup> = 0%). Additionally, no significant differences significance observed for DFS or AR (<italic>p</italic>=0.13 and <italic>p</italic>=0.73, respectively) between the AxRT and ALND groups.</p></sec><sec><title>Conclusion</title><p>Our findings suggest that survival and recurrence rates are not inferior in patients with clinical node-negative early breast cancer and a positive sentinel lymph node who receive SLNB alone compared to those undergoing ALND or AxRT.</p></sec>