Abstract

Background In 2014, the American Society of Clinical Oncology published an updated clinical practice guideline on axillary lymph node dissection (ALND) for early-stage breast cancer patients. However, these recommendations have been challenged because they were based on data from only one randomized controlled trial (RCT). We evaluated the rationale of these recommendations by systematically reviewing RCTs using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Methods We searched articles in the PubMed, EMBASE, CINAHL, Scopus, and Cochrane databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and surgical complications of axillary dissection. The quality of evidence was assessed using the GRADE profiler. Results Five eligible studies were retrieved and analyzed. We divided sentinel lymph node (SLN) metastasis into two categories: SLN micrometastasis and SLN macrometastasis. In patients with 1 or 2 SLN micrometastasis, no significant difference was observed in OS, DFS, or recurrence rate between the ALND and non-ALND groups. For patients with 1 or 2 SLN marcometastasis, only one trial with a moderate risk of bias was included, and non-ALND was the preferred management overall. However, ALND might be appropriate for patients who placed a greater emphasis on longer-term survival at any cost. Conclusion We recommend non-ALND management for early breast cancer patients with 1 or 2 SLN micrometastasis or macrometastasis on the basis of a systematic review of the current evidence conducted using the GRADE system. However, the optimal practice of evidence-based medicine should incorporate patient preferences, particularly when evidence is limited.

Original languageEnglish
Pages (from-to)73-80
Number of pages8
JournalInternational Journal of Surgery
Volume34
DOIs
Publication statusPublished - Oct 1 2016

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Lymph Node Excision
Meta-Analysis
Randomized Controlled Trials
Breast Neoplasms
Neoplasm Metastasis
Neoplasm Micrometastasis
Disease-Free Survival
Survival
Recurrence
Patient Preference
Evidence-Based Medicine
Practice Guidelines
PubMed
Sentinel Lymph Node
cyhalothrin
Dissection
Databases

Keywords

  • Axillary lymph node dissection
  • Breast cancer
  • Clinical practice guideline
  • GRADE
  • Meta-analysis
  • Recommendation
  • Sentinel lymph node metastases

ASJC Scopus subject areas

  • Surgery

Cite this

@article{4ecd632c92984ad3a330f1d27695a3a2,
title = "Recommendation for axillary lymph node dissection in women with early breast cancer and sentinel node metastasis: A systematic review and meta-analysis of randomized controlled trials using the GRADE system",
abstract = "Background In 2014, the American Society of Clinical Oncology published an updated clinical practice guideline on axillary lymph node dissection (ALND) for early-stage breast cancer patients. However, these recommendations have been challenged because they were based on data from only one randomized controlled trial (RCT). We evaluated the rationale of these recommendations by systematically reviewing RCTs using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Methods We searched articles in the PubMed, EMBASE, CINAHL, Scopus, and Cochrane databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and surgical complications of axillary dissection. The quality of evidence was assessed using the GRADE profiler. Results Five eligible studies were retrieved and analyzed. We divided sentinel lymph node (SLN) metastasis into two categories: SLN micrometastasis and SLN macrometastasis. In patients with 1 or 2 SLN micrometastasis, no significant difference was observed in OS, DFS, or recurrence rate between the ALND and non-ALND groups. For patients with 1 or 2 SLN marcometastasis, only one trial with a moderate risk of bias was included, and non-ALND was the preferred management overall. However, ALND might be appropriate for patients who placed a greater emphasis on longer-term survival at any cost. Conclusion We recommend non-ALND management for early breast cancer patients with 1 or 2 SLN micrometastasis or macrometastasis on the basis of a systematic review of the current evidence conducted using the GRADE system. However, the optimal practice of evidence-based medicine should incorporate patient preferences, particularly when evidence is limited.",
keywords = "Axillary lymph node dissection, Breast cancer, Clinical practice guideline, GRADE, Meta-analysis, Recommendation, Sentinel lymph node metastases",
author = "Huang, {Tsai Wei} and Kuo, {Ken N.} and Chen, {Kee Hsin} and Chiehfeng Chen and Hou, {Wen Hsuan} and Lee, {Wei Hwa} and Chao, {Tsu Yi} and Tsai, {Jo Ting} and Chih-Ming Su and Huang, {Ming Te} and Tam, {Ka Wai}",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.ijsu.2016.08.022",
language = "English",
volume = "34",
pages = "73--80",
journal = "International Journal of Surgery",
issn = "1743-9191",
publisher = "Elsevier Science Publishers B.V.",

}

TY - JOUR

T1 - Recommendation for axillary lymph node dissection in women with early breast cancer and sentinel node metastasis

T2 - A systematic review and meta-analysis of randomized controlled trials using the GRADE system

AU - Huang, Tsai Wei

AU - Kuo, Ken N.

AU - Chen, Kee Hsin

AU - Chen, Chiehfeng

AU - Hou, Wen Hsuan

AU - Lee, Wei Hwa

AU - Chao, Tsu Yi

AU - Tsai, Jo Ting

AU - Su, Chih-Ming

AU - Huang, Ming Te

AU - Tam, Ka Wai

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background In 2014, the American Society of Clinical Oncology published an updated clinical practice guideline on axillary lymph node dissection (ALND) for early-stage breast cancer patients. However, these recommendations have been challenged because they were based on data from only one randomized controlled trial (RCT). We evaluated the rationale of these recommendations by systematically reviewing RCTs using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Methods We searched articles in the PubMed, EMBASE, CINAHL, Scopus, and Cochrane databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and surgical complications of axillary dissection. The quality of evidence was assessed using the GRADE profiler. Results Five eligible studies were retrieved and analyzed. We divided sentinel lymph node (SLN) metastasis into two categories: SLN micrometastasis and SLN macrometastasis. In patients with 1 or 2 SLN micrometastasis, no significant difference was observed in OS, DFS, or recurrence rate between the ALND and non-ALND groups. For patients with 1 or 2 SLN marcometastasis, only one trial with a moderate risk of bias was included, and non-ALND was the preferred management overall. However, ALND might be appropriate for patients who placed a greater emphasis on longer-term survival at any cost. Conclusion We recommend non-ALND management for early breast cancer patients with 1 or 2 SLN micrometastasis or macrometastasis on the basis of a systematic review of the current evidence conducted using the GRADE system. However, the optimal practice of evidence-based medicine should incorporate patient preferences, particularly when evidence is limited.

AB - Background In 2014, the American Society of Clinical Oncology published an updated clinical practice guideline on axillary lymph node dissection (ALND) for early-stage breast cancer patients. However, these recommendations have been challenged because they were based on data from only one randomized controlled trial (RCT). We evaluated the rationale of these recommendations by systematically reviewing RCTs using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Methods We searched articles in the PubMed, EMBASE, CINAHL, Scopus, and Cochrane databases. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were recurrence rate and surgical complications of axillary dissection. The quality of evidence was assessed using the GRADE profiler. Results Five eligible studies were retrieved and analyzed. We divided sentinel lymph node (SLN) metastasis into two categories: SLN micrometastasis and SLN macrometastasis. In patients with 1 or 2 SLN micrometastasis, no significant difference was observed in OS, DFS, or recurrence rate between the ALND and non-ALND groups. For patients with 1 or 2 SLN marcometastasis, only one trial with a moderate risk of bias was included, and non-ALND was the preferred management overall. However, ALND might be appropriate for patients who placed a greater emphasis on longer-term survival at any cost. Conclusion We recommend non-ALND management for early breast cancer patients with 1 or 2 SLN micrometastasis or macrometastasis on the basis of a systematic review of the current evidence conducted using the GRADE system. However, the optimal practice of evidence-based medicine should incorporate patient preferences, particularly when evidence is limited.

KW - Axillary lymph node dissection

KW - Breast cancer

KW - Clinical practice guideline

KW - GRADE

KW - Meta-analysis

KW - Recommendation

KW - Sentinel lymph node metastases

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U2 - 10.1016/j.ijsu.2016.08.022

DO - 10.1016/j.ijsu.2016.08.022

M3 - Review article

VL - 34

SP - 73

EP - 80

JO - International Journal of Surgery

JF - International Journal of Surgery

SN - 1743-9191

ER -