Sentinel Lymph Node Biopsy vs. Axillary Lymph Node Dissection for Early-Stage Breast Cancer and Sentinel Lymph Node Metastasis: An Updated Systematic Review and Meta-Analysis With Special Focus on Locoregional Recurrence and Regional Node Irradiation

This meta-analysis suggests that SLNB, with or without RNI, offers comparable OS and DFS to ALND for early breast cancer patients with metastasis-positive SLNs. However, the inclusion of studies that did not differentiate between micrometastases and macrometastases may introduce bias, particularly when assessing the impact of RNI. The role of RNI remains debated specially in those with macrometastases, and future research should focus on stratified analyses to clarify this. While SLNB represents a viable alternative to ALND, further trials are needed to define the optimal role in subgroups with high-risk tumor biology.