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Meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery.

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Title: Meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery.
Authors: Kedrzycki, MS
Leiloglou, M
Ashrafian, H
Jiwa, N
Thiruchelvam, PTR
Elson, DS
Leff, DR
Item Type: Journal Article
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.
Issue Date: 1-Jul-2021
Date of Acceptance: 27-Sep-2020
URI: http://hdl.handle.net/10044/1/84125
DOI: 10.1245/s10434-020-09288-7
ISSN: 1068-9265
Publisher: Springer
Start Page: 3738
End Page: 3748
Journal / Book Title: Annals of Surgical Oncology
Volume: 28
Copyright Statement: © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Sponsor/Funder: Cancer Research UK
AstraZeneca UK Limited
Wellcome Trust
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Medical Research Council (MRC)
National Institute for Health Research
Funder's Grant Number: 25147
PO 8300419389
RDB04 79560
RD207
MC_PC_13064
II-LB-0214-20009
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Surgery
INDOCYANINE GREEN FLUORESCENCE
AXILLARY DISSECTION
METHYLENE-BLUE
ISOSULFAN BLUE
PATENT BLUE
OPEN-LABEL
BIOPSY
LYMPHADENECTOMY
MULTICENTER
TRIAL
Breast Neoplasms
Coloring Agents
Female
Fluorescence
Humans
Indocyanine Green
Optical Imaging
Radioisotopes
Sentinel Lymph Node
Sentinel Lymph Node Biopsy
Humans
Breast Neoplasms
Radioisotopes
Indocyanine Green
Sentinel Lymph Node Biopsy
Fluorescence
Coloring Agents
Female
Optical Imaging
Sentinel Lymph Node
Oncology & Carcinogenesis
1112 Oncology and Carcinogenesis
Publication Status: Published
Conference Place: United States
Online Publication Date: 2020-11-06
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation



This item is licensed under a Creative Commons License Creative Commons