Comment: The quality of evidence is downgraded by imprecise results (few outcome events).
A Cochrane review [Abstract] 1 included 26 studies with operable primary breast cancer.
No axillary surgery versus axillary lymph node dissection (ALND) (10 trials, n=3 849): There were no important differences between overall survival although no axillary surgery increased the risk of locoregional recurrence but also decreased the risk of lymphoedema (table T1).
Axillary sampling versus ALND (6 trials, n=1 559): There was similar effectiveness in terms of overall survival but it was unclear whether axillary sampling led to increased risk of local recurrence (table T2).
Sentinel lymph node biopsy (SLNB) versus ALND (7 trials, n=9 426): There was similar overall survival (table T3). Differences in local recurrence, locoregional recurrence and distant metastasis were uncertain.
| Outcomes | Relative effect(95% CI) | Assumed risk - Control - Full axillary surgery | Corresponding risk - Intervention - No axillary surgery (95% CI) | No of participants(studies) Quality of evidence |
|---|---|---|---|---|
| All-cause mortality at 5 years | HR 1.06 (0.96 to 1.17) | 92% overall survival | 92% overall survival (91% to 93%) | 3 849(10) Moderate |
| Locoregional recurrence at 5 years | HR 2.35 (1.91 to 2.89) | 86% locoregional recurrence-free survival | 71% locoregional recurrence-free survival (66% to 76%) | 20 863(5) Moderate |
| Lymphoedema: Increase in arm circumference Follow-up: 1 or more years | OR 0.31 (0.23 to 0.43) | 236 per 1000 | 87 per 1000(66 to 117) | 1 714(4) Low |
| Arm or shoulder movement impairmentFollow-up: 1 or more years | OR 0.72 (0.49 to 1.05) | 91 per 1000 | 67 per 1000(47 to 95) | 1495(5) Very low |
| Outcomes | Relative effect(95% CI) | Assumed risk - Control - Full axillary surgery | Corresponding risk - Intervention - Axillary sampling (95% CI) | No of participants(studies) Quality of evidence |
|---|---|---|---|---|
| All-cause mortality at 5 years | HR 0.94 (0.73 to 1.21) | 82% overall survival | 83% overall survival (79% to 87%) | 967(3) Low |
| Local recurrence at 5 years | HR 1.41 (0.94 to 2.12) | 85% local recurrence-free survival | 80% local recurrence free survival (71% to 86%) | 1 404(3) Low |
| Outcomes | Relative effect(95% CI) | Assumed risk - Control - Full axillary surgery | Corresponding risk - Intervention - Sentinel node biopsy (95% CI) | No of participants(studies) Quality of evidence |
|---|---|---|---|---|
| All-cause mortality at 5 years | HR 1.05 (0.89 to 1.25) | 96% overall survival | 96% overall survival (95% to 96%) | 6 352(3) Moderate |
| Lymphoedema (subjective): Follow-up: 1 year | OR 0.33 (0.15 to 0.86) | 132 per 1000 | 48 per 1000(22 to 115) | 815(3) Low |
| Subjective arm movement impairmentFollow-up: 1 year | OR 0.38 (0.22 to 0.67) | 100 per 1000 | 40 per 1000(24 to 69) | 877(2) Very low |
| NumbnessFollow-up: 1 year | OR 0.43 (0.34 to 0.54) | 346 per 1000 | 185 per 1000(152 to 222) | 1 799(3) Moderate |
Date of latest search: 12 March 2015
Primary/Secondary Keywords