Table 4.
Studies on predicting the status of axillary lymph nodes after NAC
| Study | Period | Type | Inclusion | n | Means of prediction | FNR |
|---|---|---|---|---|---|---|
| TAD [84] | 2011-2015 | prospective | cN+ post-NAC | 208 | 115 clipped node; | SLN alone: 10.1% |
| 118 SLND | SLN + clipped node: 1.4% | |||||
| SENTINA [77] | 2009-2012 | prospective | - | 1737 | arm A: cN0 SLND before | 1 SLN: 24.3%; |
| NAC | 2 SLNs: 18.5%; | |||||
| arm B: pN1 second SLND | more than 2 SLNDs: ≤10%. | |||||
| arm C: cN1 to ycN0 ALND+SLND | blue dye + radionuclide: 8.6% | |||||
| arm D: ycN1 ALND no SLND | radionuclide alone: 16.0% | |||||
| ACOSOG Z1071 [79] | 2009-2011 | prospective | T0-4, N1-2, M0 | 756 | 16.8% radiolabelled colloid; | 2 or more SLNs: ≤10% |
| 4.1% blue dye; | blue dye + radionuclide: 10.8% | |||||
| 79.1% combined | radionuclide or dye alone: 20.3% | |||||
| 12.0% 1 SLN; | ||||||
| 88.0% 2 or more SLNs | ||||||
| GANEA2 [83] | 2010-2014 | prospective | T1-3, N0-2, M0 | 957 | 419 cN0 SLND; | 1 SLN: 19.3% |
| 307 pN1 | 2 or more SLNs: 7.8% | |||||
| Donker [86] | 2008-2012 | retrospective | - | 100 | MARI node identified and ALND performed (n = 95) | FNR: 7%; NPV: 83% |
| sensitivity: 90% | ||||||
| specificity: 100% | ||||||
| Koolen [87] | 2008-2012 | prospective | T2-3, cN+ | 93 | - | Combining PET-CT before NAC and the MARI procedure after NAC has the potential for ALND to be avoided in 74% of patients |
| Swarnkar [85] | - | pooled analysis | - | MLNB, 366; TAD, 521 | MLNB and TAD | FNR was 6.28% for MLNB; FNR of 5.18% for TAD |
Abbreviations: NAC, neoadjuvant chemotherapy; pCR, pathological complete response; ALND: axillary lymph node dissection, SLND: sentinel lymph node biopsy, RT: radiotherapy treatment, MARI: marking the axillary lymph node with radioactive iodine (125I) seeds, PET-CT: positron emission tomography-computed tomography, FNR: false-negative rate, NPV: negative predictive values, SLN: sentinel lymph node; MLNB: marked lymph node biopsy.