Abstract
Abstract
Introduction
Conventional methods for axillary sentinel lymph node biopsy (SLNB) are fraught with complications such as allergic reactions, skin tattooing, radiation, and limitations on infrastructure. A novel technique has been developed for lymphatic mapping utilizing fluorescence imaging. This meta-analysis aims to compare the gold standard blue dye and radioisotope (BD-RI) technique with fluorescence-guided SLNB using indocyanine green (ICG).
Methods
This study was registered with PROSPERO (CRD42019129224). The MEDLINE, EMBASE, Scopus, and Web of Science databases were searched using the Medical Subject Heading (MESH) terms ‘Surgery’ AND ‘Lymph node’ AND ‘Near infrared fluorescence’ AND ‘Indocyanine green’. Studies containing raw data on the sentinel node identification rate in breast cancer surgery were included. A heterogeneity test (using Cochran’s Q) determined the use of fixed- or random-effects models for pooled odds ratios (OR).
Results
Overall, 1748 studies were screened, of which 10 met the inclusion criteria for meta-analysis. ICG was equivalent to radioisotope (RI) at sentinel node identification (OR 2.58, 95% confidence interval [CI] 0.35–19.08, p < 0.05) but superior to blue dye (BD) (OR 9.07, 95% CI 6.73–12.23, p < 0.05). Furthermore, ICG was superior to the gold standard BD-RI technique (OR 4.22, 95% CI 2.17–8.20, p < 0.001).
Conclusion
Fluorescence imaging for axillary sentinel node identification with ICG is equivalent to the single technique using RI, and superior to the dual technique (RI-BD) and single technique with BD. Hospitals using RI and/or BD could consider changing their practice to ICG given the comparable efficacy and improved safety profile, as well as the lesser burden on hospital infrastructure.
Publisher
Springer Science and Business Media LLC
Reference61 articles.
1. Jauhari Y, Gannon M, Medina J, Cromwell DA, Horgan K, Dodwell D. National Audit of Breast Cancer in Older Patients. Healthcare Quality Improvement Partnership National Clinical Audit and Patient Outcomes Programme. 2018. Available at:
https://www.hqip.org.uk/wp-content/uploads/2018/06/ref58_Breast-Cancer_NABCOP-2018-Annual-Report-v1.1_correction.pdf
. Accessed 2 Dec 2019.
2. Cox CE, Bass S, Ku NN, Berman CG, Shons AR, Yeatman T, et al. Sentinel lymphadenectomy: a safe answer to less axillary surgery? Recent Results Cancer Res. 1998;152: 170–179.
3. Doting MHE, Jansen L, Nieweg OE, Piers DA, Tiebosch ATMG, Schraffordt Koops H, et al. Lymphatic mapping with intra-lesional tracer administration in breast cancer patients. Cancer. 2000;88:2546–552.
4. Giuliano AE, Haigh PI, Brennan MB, Hansen NM, Kelley MC, Ye W, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol. 2000;18:2553–559.
5. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.