Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Brea
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REVIEW ARTICLE – BREAST ONCOLOGY
Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery Martha S. Kedrzycki, MSc, MRCS1,2,3 , Maria Leiloglou, MSc1,2, Hutan Ashrafian, MBA, MRCS, PhD2, Natasha Jiwa, MBBS, BSc, MRCS2,3, Paul T. R. Thiruchelvam, MSc, FRCS, PhD2,3, Daniel S. Elson, MPhys, PhD1,2, and Daniel R. Leff, FRCS, PhD, MS (Hons)2,3 1
Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK; 2Department of Surgery and Cancer, Imperial College London, London, UK; 3Department of Breast Surgery, Imperial Healthcare Trust, London, UK
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).
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09288-7) contains supplementary material, which is available to authorized users. Ó The Author(s) 2020 First Received: 10 June 2020 Accepted: 27 September 2020 M. S. Kedrzycki, MSc, MRCS e-mail: [email protected]
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 (RIBD) 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.
The vast majority (* 90%) of clinically node-negative breast cancer patients undergo a sentinel lymph node biopsy (SLNB) staging procedure.1 During SLNB, lymph nodes are sampled to assess whether any metastatic spread has occurred. The aim is to accurately identify the ‘sentinel’ or guardian nodes th
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