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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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Disclosures

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands

    Suzanne C. E. Diepstraten MD, Constantinus F. M. Buckens MD, Wouter B. Veldhuis MD, PhD, Maurice A. A. J. van den Bosch MD, PhD, Willem P. Th. M. Mali MD, PhD & Helena M. Verkooijen MD, PhD

  2. Department of Radiology, Maidstone Hospital, Maidstone, Kent, UK

    Ali R. Sever MD, PhD

  3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Constantinus F. M. Buckens MD

  4. Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands

    Thijs van Dalen MD, PhD

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  1. Suzanne C. E. Diepstraten MD
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  2. Ali R. Sever MD, PhD
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Correspondence to Suzanne C. E. Diepstraten MD.

Additional information

Suzanne C. E. Diepstraten and Ali R. Sever are the joint first authors.

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Diepstraten, S.C.E., Sever, A.R., Buckens, C.F.M. et al. 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. Ann Surg Oncol 21, 51–59 (2014). https://doi.org/10.1245/s10434-013-3229-6

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  • DOI: https://doi.org/10.1245/s10434-013-3229-6

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