META-ANALYSIS OF SENTINEL LYMPH NODE BIOPSY (SLNB) VS. AXILLARY LYMPH NODE DISSECTION (ALND) IN BREAST CANCER SURGERY

Different types of surgery for breast cancer treatment include sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND). This meta-analysis aims to analyze the oncological effect, complications, and quality of life after the two surgeries. A systematic search for clinical trials, cohort studies, and propensity score matching analysis was conducted using the major electronic databases. Altogether, the authors of 12 studies, including 6450 patients, evaluated the results. With clinically negative axillae, SLNB was as effective as ALND in terms of disease-free survival and overall survival in early breast cancer. It was associated with substantially lower rates of postoperative morbidity, such as lymphedema, pain, and shoulder dysfunction, compared to ALND. For patients with minimal nodal burden, SLNB followed by systemic therapy appropriate to the primary tumor was not inferior to ALND for regional control; however, ALND remained crucial for patients with extensive disease in the axilla. The results highlighted the benefits of SLNB in relation to its impact on the quality of life of patients without impacting the oncological outcome in appropriate patient populations to support the utilization of SLNB. Nevertheless, the benefits of SLNB are apparent, and further work is needed to narrow the criteria that would qualify a patient for the surgery and to apply SLNB in an individualized approach.