The Metastasis Of Internal Mammary Sentinel Nodes(IMSN)in Patients With A Diagnostic Of Clinically Node-negative Primary Breast Cancer:A Meta-analysis

PurposeThe utility of the IMSN is still limited for the lack of uniform recognization in the feasibility and necessity.We conducted this meta-analysis to report a pooled positive rate of the IMSN obtained from the clinically node-negative primary breast cancer patients as well as the relative factors concomitantly which provide help for the subsequent treatment.Materials and Methodswe searched the eligible studies from three electronic databases(PubMed,EMBASE and Cochrane Library)to identify all relevant available articles from January 1970 to January 2017.The quality assessment of the included articles was made by using Newcastle-Ottawa Scale.The heterogeneity was evaluated by using I2-statistics and Q-statistics.The funnel plots and the Egger's test were used to inspect publication bias.The pooled positive rate of IMSN was reported with the use of fix-effect model.ResultsTwenty-one studies(n=2014)reported the rate of IMSN involvement were included in this review.Overall,the pooled positive rate of IMSN was 16.8%(CI 0.14-0.22,P<0.001)with a moderate heterogeneity(I2=64.1%,P<0.001).The subgroup analysis showed that both subgroup had a smaller heterogeneity and the radioisotope and blue dye group had a high positive IMSN rate(19.1%CI 0.16-0.21,P<0.001)than the radioisotope group(10.0%,CI 0.06-0.14,P=0.008).The relative factors estimate for positive rate of IMSN are axillary status 2.70,(CI 1.77-4.12,P<0.001),tumor location 1.79,CI 1.07-3.00,P=0.026),tumor diameter 1.25(CI 0.64-2.44,P=0.505)ConclusionIt is utility to conduct a preoperative IMSN visualization and a subsequently selective biopsy is also recommended for the primary breast cancer patients which have clinically negative nodes,especially for those with involved axillary.