| Objective This study aimed to analyze the efficacy and safety of sentinel lymph node biopsy(SLNB)after neoadjuvant chemotherapy(NAC)in patients with initial axillary lymph node-positive breast cancer.The efficacy is the sentinel lymph node(SLN)detection rate and the accuracy rate of SLNB.Safety refers to the false-negative rate of SLNB,and a subgroup analysis of clinic pathological factors that may affect false-negative rates is made.To find a reliable method to reduce the false-negative rate of SLNB.Methods The five databases of Cochrane Library、Embase、Pubmed、CNKI 、Wan Fang were searched from January 2000 to May 2021.The retrieved literature was screened according to the inclusion and exclusion criteria to obtain the literature finally included in the Meta-analysis.And the SLN detection rate,SLNB accuracy,and SLNB false-negative rate were extracted from the literature and combined with Stata 14.0 software to obtain the forest map.Stata 14.0 software was used for sensitivity analysis and publication bias test.Results 28 kinds of literature were included in the Meta-analysis.A total of 3519 breast cancer patients were included.The identification rate of SLN was 92%(95% CI:0.88-0.95);the accuracy of SLNB was 93%(95% CI:0.91-0.94);the false-negative rate of SLNB was 13%(95% CI:0.10-0.15).There are 23 literatures that can conduct subgroup analysis on the influencing factors of false-negative rate: the false-negative rate of SLNB with double tracer was 10%(95% CI:0.07-0.14),and that with single tracer was 12%(95% CI:0.05-0.20);when one SLN was detected,the false-negative rate was 18%(95% CI:0.10-0.26),when two SLNs was detected,the false-negative rate was 15%(95% CI:0.06-0.24),when more than three SLNs were detected,the false-negative rate was 5%(95% CI:-0.00-0.11);the false-negative rate was 5%(95% CI:0.01-0.09)when the SLN were removed and the metastatic lymph nodes were also removed,only SLN were removed under the same test conditions,the falsenegative-rate was 14%(95% CI:0.11-0.17);the false-negative rate was 7%(95%CI:0.03-0.11)in patients with N1 stage at the initial diagnosis,and 22%(95% CI:0.10-0.33)in patients with ≥N2 stage at the initial diagnosis;the false-negative rate was 11%(95% CI:0.07-0.16)in patients with ≤ T2 stage at the initial diagnosis,and 10%(95% CI:0.02-0.18)in patients with > T2 stage at the initial diagnosis;after NAC,the false-negative rate was 9%(95% CI:0.01-0.18)in patients with clinical complete remission(c CR),and 19%(95% CI:0.13-0.25)in patients without clinical complete remission;the false-negative rate of patients with molecular typing of Luminal A was 16%(95% CI:0.10-0.23),that of patients with Luminal B was 17%(95% CI:0.10-0.24),that of patients with HER-2 positive was 5%(95% CI:-0.01-0.11),and that of patients with Triple Negative was 7%(95% CI:-0.01-0.15).Sensitivity analysis showed that the results of this Meta-analysis were stable,and the publication bias test showed that there was no publication bias in this Meta-analysis,which has a certain reference value.Conclusion For HER-2 positive or Triple Negative breast cancer patients with N1 stage convert to axillary negative after NAC,positive lymph nodes were labeled before NAC,SLN was located by double tracer method,and positive lymph nodes were removed together with SLN in SLNB,at the same time,more than 3 SLNs were detected,and an ideal false-negative rate could be obtained. |
