Axillary Recurrence After a Negative Sentinel Lymph Node Biopsy (SLNB) for Initial Positive Node Breast Cancer Postneoadjuvant Therapy: Insights From a Systematic Review and Meta-Analysis

Abstract

Background

Despite the use of sentinel lymph node biopsy (SLNB) to stage the axilla in clinically node-negative breast cancer patients’ postneoadjuvant therapy, the incidence and clinical significance of axillary recurrence (AR) after a negative SLNB remain under-explored in the literature. Understanding these factors is essential to improving patient outcomes and guiding future treatment strategies.

Methods

We conducted a systematic review and meta-analysis using PubMed, Scopus, ScienceDirect, and Google Scholar. A random effects model was used to calculate pooled incidence of AR, while heterogeneity was assessed using the I² and Q-statistics. Publication bias was evaluated with a funnel plot and Egger’s test. We performed all analyses using the R meta and metafor packages.

Results

A total of 37 studies were included in the qualitative synthesis and meta-analysis. The pooled analysis of these studies highlights a remarkably low incidence of AR, with an overall proportion of 1% (95% CI: [0.0%, 1.0%]) under a random-effects model and no significant heterogeneity (I² = 0%, p = 0.95). Egger’s test for publication bias was conducted to assess the presence of funnel plot asymmetry in the meta-analysis, indicating no significant evidence of publication bias (z-value = 0.6074, p-value = 0.5436).

Conclusion

The meta-analysis demonstrated a remarkably low incidence of AR after a negative SLNB in initially node-positive breast cancer patients postneoadjuvant therapy. These findings suggest that such recurrences are rare, supporting the reliability of SLNB in accurately staging the axilla. This highlights its importance in clinical decision-making for treatment strategies.