Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
UMass Chan Affiliations
Department of Medicine, Division of Preventive and Behavioral MedicineDocument Type
Journal ArticlePublication Date
2015-08-01Keywords
Antineoplastic AgentsAxilla
Bayes Theorem
Breast Neoplasms
False Negative Reactions
Female
Humans
Lymph Nodes
Lymphatic Metastasis
Prospective Studies
SEER Program
Sentinel Lymph Node Biopsy
Accuracy
Axilla
Axillary dissection
Likelihood ratios
Sentinel node biopsy
Diagnosis
Neoplasms
Surgical Procedures, Operative
Women's Health
Metadata
Show full item recordAbstract
Prospective trials investigating the accuracy of SLNB for cN0 (primary surgical therapy) and cN1 patients (neoadjuvant chemotherapy) have not utilized likelihood ratios (LR) to assess the impact of false negative SLNB. This review evaluates the evidence on accuracy of SLNB using STARD and QUADAS-2 (revised) criteria for patients undergoing primary surgical therapy and primary chemotherapy. It utilizes the: (i) Reported rates for pre-test probabilities of node positive disease from Surveillance, Epidemiology, and End Results (SEER) database for the cN0 patients (primary surgical therapy) for each T stage; calculates the negative LR from cumulative evidence; and uses the Bayesian nomogram to compute the post-test probability of missing the metastatic axillary node based on negative SLNB. (ii) Reported rates of complete axillary response in ACOSOG-Z1071 trial for cN1 patients to calculate the pre-test probabilities of residual nodal disease for each biological tumor sub-type; calculates the negative LR from ACOSOG-Z1071, and SENTINA trial data; and uses the Bayesian nomogram to compute the post-test probability of missing the residual metastatic axillary node based on negative SLNB. For cN0 disease, the odds of missing axillary disease based on negative SLNB for each T stage are: T1a = 0.7%; T1b = 1.5%; T1c = 3%; T2 = 7%; T3 = 18%. For cN1 disease, the odds of missing residual axillary disease based on negative SLNB for each biological subtype are: HER2neu+ = 8%; Triple negative = 15%; ER+/PR+/HER2neu- = 45%. Negative LR is more accurate and superior to false negative rate for determining the clinical utility of SLNB by taking into account the changing pre-test probability of disease.Source
Breast. 2015 Aug;24(4):343-53. doi: 10.1016/j.breast.2015.03.010. Epub 2015 Apr 27. Link to article on publisher's siteDOI
10.1016/j.breast.2015.03.010Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30672PubMed ID
25937264Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.breast.2015.03.010