A systematic review of the impact of neoadjuvant chemotherapy on axillary lymph node yield in early and locally advanced breast cancer.
Association of Breast Surgery ePoster Library. Saha S. 05/15/17; 166334; P077
Ms. Sunita Saha
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Rate & Comment (0)
Introduction: Current guidelines recommend a minimum of ten axillary nodes are retrieved at axillary node dissection for optimal prognostic staging and loco-regional control. This key quality performance indicator is dependent on the extent of surgical dissection and pathologist diligence. It has been suggested neoadjuvant chemotherapy also affects nodal counts. We aimed to clarify whether neoadjuvant chemotherapy truly impacts nodal yield and if the application of this performance indicator is inappropriate for this subgroup.
Methods: In accordance with PRISMA guidelines a search was undertaken of Cochrane, PubMed, EMBASE and ICTRP databases from January 1980 to October 2015. Studies examining the impact of neoadjuvant chemotherapy on axillary dissection nodal counts as outlined in the PROSPORO registered protocol (No. CRD42015025146) were identified. After primary selection, two reviewers independently assessed the content of each eligible study using a standardised extraction form and pre-defined inclusion and exclusion criteria. Revman software with random effects analysis model was used to analyse data.
Results: 3733 patients from ten studies fulfilled the review protocol and quality criteria. Seven of the ten studies reported significantly lower lymph node yields after neoadjuvant chemotherapy. Summary data of studies which dichotomized their results, assessing the proportion in each group where <10 lymph nodes were resected. The resultant forest plot demonstrated that neoadjuvant chemotherapy more frequently led to a less than minimum lymph node yield.
Conclusions:
The historical recommendation of a minimum of ten lymph yield at axillary node dissection should be reconsidered in patients having neoadjuvant chemotherapy for breast cancer.
Methods: In accordance with PRISMA guidelines a search was undertaken of Cochrane, PubMed, EMBASE and ICTRP databases from January 1980 to October 2015. Studies examining the impact of neoadjuvant chemotherapy on axillary dissection nodal counts as outlined in the PROSPORO registered protocol (No. CRD42015025146) were identified. After primary selection, two reviewers independently assessed the content of each eligible study using a standardised extraction form and pre-defined inclusion and exclusion criteria. Revman software with random effects analysis model was used to analyse data.
Results: 3733 patients from ten studies fulfilled the review protocol and quality criteria. Seven of the ten studies reported significantly lower lymph node yields after neoadjuvant chemotherapy. Summary data of studies which dichotomized their results, assessing the proportion in each group where <10 lymph nodes were resected. The resultant forest plot demonstrated that neoadjuvant chemotherapy more frequently led to a less than minimum lymph node yield.
Conclusions:
The historical recommendation of a minimum of ten lymph yield at axillary node dissection should be reconsidered in patients having neoadjuvant chemotherapy for breast cancer.
Introduction: Current guidelines recommend a minimum of ten axillary nodes are retrieved at axillary node dissection for optimal prognostic staging and loco-regional control. This key quality performance indicator is dependent on the extent of surgical dissection and pathologist diligence. It has been suggested neoadjuvant chemotherapy also affects nodal counts. We aimed to clarify whether neoadjuvant chemotherapy truly impacts nodal yield and if the application of this performance indicator is inappropriate for this subgroup.
Methods: In accordance with PRISMA guidelines a search was undertaken of Cochrane, PubMed, EMBASE and ICTRP databases from January 1980 to October 2015. Studies examining the impact of neoadjuvant chemotherapy on axillary dissection nodal counts as outlined in the PROSPORO registered protocol (No. CRD42015025146) were identified. After primary selection, two reviewers independently assessed the content of each eligible study using a standardised extraction form and pre-defined inclusion and exclusion criteria. Revman software with random effects analysis model was used to analyse data.
Results: 3733 patients from ten studies fulfilled the review protocol and quality criteria. Seven of the ten studies reported significantly lower lymph node yields after neoadjuvant chemotherapy. Summary data of studies which dichotomized their results, assessing the proportion in each group where <10 lymph nodes were resected. The resultant forest plot demonstrated that neoadjuvant chemotherapy more frequently led to a less than minimum lymph node yield.
Conclusions:
The historical recommendation of a minimum of ten lymph yield at axillary node dissection should be reconsidered in patients having neoadjuvant chemotherapy for breast cancer.
Methods: In accordance with PRISMA guidelines a search was undertaken of Cochrane, PubMed, EMBASE and ICTRP databases from January 1980 to October 2015. Studies examining the impact of neoadjuvant chemotherapy on axillary dissection nodal counts as outlined in the PROSPORO registered protocol (No. CRD42015025146) were identified. After primary selection, two reviewers independently assessed the content of each eligible study using a standardised extraction form and pre-defined inclusion and exclusion criteria. Revman software with random effects analysis model was used to analyse data.
Results: 3733 patients from ten studies fulfilled the review protocol and quality criteria. Seven of the ten studies reported significantly lower lymph node yields after neoadjuvant chemotherapy. Summary data of studies which dichotomized their results, assessing the proportion in each group where <10 lymph nodes were resected. The resultant forest plot demonstrated that neoadjuvant chemotherapy more frequently led to a less than minimum lymph node yield.
Conclusions:
The historical recommendation of a minimum of ten lymph yield at axillary node dissection should be reconsidered in patients having neoadjuvant chemotherapy for breast cancer.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}