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Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery

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 m...

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Autores principales: Kedrzycki, Martha S., Leiloglou, Maria, Ashrafian, Hutan, Jiwa, Natasha, Thiruchelvam, Paul T. R., Elson, Daniel S., Leff, Daniel R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184731/
https://www.ncbi.nlm.nih.gov/pubmed/33156466
http://dx.doi.org/10.1245/s10434-020-09288-7
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author Kedrzycki, Martha S.
Leiloglou, Maria
Ashrafian, Hutan
Jiwa, Natasha
Thiruchelvam, Paul T. R.
Elson, Daniel S.
Leff, Daniel R.
author_facet Kedrzycki, Martha S.
Leiloglou, Maria
Ashrafian, Hutan
Jiwa, Natasha
Thiruchelvam, Paul T. R.
Elson, Daniel S.
Leff, Daniel R.
author_sort Kedrzycki, Martha S.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1245/s10434-020-09288-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-81847312021-06-25 Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery Kedrzycki, Martha S. Leiloglou, Maria Ashrafian, Hutan Jiwa, Natasha Thiruchelvam, Paul T. R. Elson, Daniel S. Leff, Daniel R. Ann Surg Oncol Breast Oncology 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1245/s10434-020-09288-7) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-11-06 2021 /pmc/articles/PMC8184731/ /pubmed/33156466 http://dx.doi.org/10.1245/s10434-020-09288-7 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis 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/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Breast Oncology
Kedrzycki, Martha S.
Leiloglou, Maria
Ashrafian, Hutan
Jiwa, Natasha
Thiruchelvam, Paul T. R.
Elson, Daniel S.
Leff, Daniel R.
Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery
title Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery
title_full Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery
title_fullStr Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery
title_full_unstemmed Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery
title_short Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery
title_sort meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery
topic Breast Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184731/
https://www.ncbi.nlm.nih.gov/pubmed/33156466
http://dx.doi.org/10.1245/s10434-020-09288-7
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