Axillary lymph node dissection vs. sentinel node biopsy for early-stage clinically node-negative breast cancer: a systematic review and meta-analysis

omicron bjective This study aimed at comparing survival outcomes between systematic axillary lymph node dissection (ALND) vs sentinel lymph node and axillary lymph node dissection only if sentinel positive (SLN +/- ALND) in early-stage, clinically node-negative breast cancer patients. Methods A systematic review and meta-analysis adhered to PRISMA guidelines was performed. Included studies were prospective randomized controlled trials (RCTs) comparing survival outcomes of ALND vs. SLN +/- ALND in early-stage, node-negative breast cancer patients. Patients enrolled were only those with tumor size lower than 4 cm, clinically negative nodes and treated with breast-conservative surgery. Primary endpoints were locoregional recurrence, overall death and cancer-related death. Results There were four studies included in the analysis, enrolling overall 2982 patients, of which 1494 in ALND arm and 1488 in the SLN +/- ALND arm. No statistically significant difference was observed in locoregional recurrence, breast cancer-related death and overall death. Locoregional recurrence was observed in 2.8% (ALND) vs. 4.1% (SLND +/- ALND), (RR 0.69, 95% CI 0.20-2.30). Overall death rate was 7.0% vs. 6.8% respectively, (RR 1.00, 95% CI 0.73-1.39, I-2 = 28.7%). Breast cancer-related death was 3.6% vs. 3.5%, respectively (SLN +/- ALND), (RR 1.11, 95% CI 0.70-1.78, I-2 = 0%). No statistically significant difference was observed in any of secondary study outcomes. Conclusions Systematic axillary axillary lymph node dissection provides no survival benefit compared with sentinel lymph node dissection for early-stage clinically node-negative breast cancer patients.

Automated summary

This study compared the survival outcomes of systematic axillary lymph node dissection (ALND) with sentinel lymph node dissection (SLN +/- ALND) in early-stage clinically node-negative breast cancer patients. The results showed that there was no significant difference in survival outcomes between the two procedures.