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The False-Negative Rate of Sentinel Node Biopsy in Patients with Breast Cancer: A Meta-Analysis

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Abstract

Background

In sentinel node surgery for breast cancer, procedural accuracy is assessed by calculating the false-negative rate. It is important to measure this since there are potential adverse outcomes from missing node metastases. We performed a meta-analysis of published data to assess which method has achieved the lowest false-negative rate.

Methods

We found 3,588 articles concerning sentinel nodes and breast cancer published from 1993 through mid-2011; 183 articles met our inclusion criteria. The studies described in these 183 articles included a total of 9,306 patients. We grouped the studies by injection material and injection location. The false-negative rates were analyzed according to these groupings and also by the year in which the articles were published.

Results

There was significant variation related to injection material. The use of blue dye alone was associated with the highest false-negative rate. Inclusion of a radioactive tracer along with blue dye resulted in a significantly lower false-negative rate. Although there were variations in the false-negative rate according to injection location, none were significant.

Conclusions

The use of blue dye should be accompanied by a radioactive tracer to achieve a significantly lower false-negative rate. Location of injection did not have a significant impact on the false-negative rate. Given the limitations of acquiring appropriate data, the false-negative rate should not be used as a metric for training or quality control.

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Acknowledgments

This study was funded by grant 4R01CA074137-12, Sentinel Node Versus Axillary Dissection in Breast Cancer.

Conflict of interest

Dr. David Krag has a financial interest in treeofmedicine.com. Sarah Pesek, Taka Ashikaga, and Lars Erik Krag have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. University of Vermont College of Medicine, Burlington, VT, 05405, USA

    Sarah Pesek, Taka Ashikaga & David Krag

  2. Department of Surgery, Stavanger University Hospital, Stavanger, Norway

    Lars Erik Krag

  3. Department of General Surgery, University of Vermont College of Medicine, Health Science Complex, Room E309C, Burlington, VT, 05405, USA

    David Krag

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  1. Sarah Pesek
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  2. Taka Ashikaga
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  3. Lars Erik Krag
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  4. David Krag
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Correspondence to David Krag.

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Pesek, S., Ashikaga, T., Krag, L.E. et al. The False-Negative Rate of Sentinel Node Biopsy in Patients with Breast Cancer: A Meta-Analysis. World J Surg 36, 2239–2251 (2012). https://doi.org/10.1007/s00268-012-1623-z

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