The Application of Magnetic Nanoparticles for Sentinel Lymph Node Detection in Clinically Node-Negative Breast Cancer Patients: A Systemic Review and Meta-Analysis

SIMPLE SUMMARY: Generally, the standard method of applying sentinel lymph node biopsy in breast cancer patients is via a technetium-labeled nanocolloid (radiolabeled tracer) with or without blue dye. However, the radioactive agents may cause challenges both to hospitals and patients. Alternatively, a safer candidate method, such as SPIO, has been often introduced and validated in comparison with standard methods. The aim of this study was to perform a systematic review and meta-analysis to evaluate the diagnostic accuracy of SPIO and its clinical impact on the management of breast cancer. Based on our study, SPIO could be considered as an alternative standard of care for sentinel lymph node detection. Compared with the standard method, SPIO exhibited equivalent or even superior detection capacities, while safety could be guaranteed. Lower SPIO doses would also not impair detection capacity compared with the standard method. The absence of radioactivity of SPIO is one of the most important advantages for clinical applications. ABSTRACT: Superparamagnetic iron oxide (SPIO), an alternative mapping agent, can be used to identify sentinel lymph nodes in patients with clinically node-negative breast cancer. However, its performance in comparison with the standard method, using a radioisotope (technetium-99 m, Tc) alone or in combination with blue dye, remains controversial. Hence, a systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of SPIO and its clinical impact in the management of breast cancer. The PubMed, Embase, and Cochrane databases were comprehensively searched from inception to 1 May 2022. Cohort studies regarding the comparison of SPIO with standard methods for sentinel lymph node identification were included. A total of 19 prospective cohort studies, which collectively included 2298 clinically node-negative breast cancer patients undergoing sentinel lymph node identification through both the standard method and SPIO, were identified. The detection rate for sentinel lymph nodes (RR, 1.06; 95% CI, 1.05–1.08; p < 0.001) was considerably higher in the SPIO cohorts than in the standard method cohorts, although this difference was not significant in detected patients, patients with positive sentinel lymph nodes, or positive sentinel lymph nodes. Compared with the standard method, the SPIO method could be considered as an alternative standard of care for sentinel lymph node detection in patients with clinically node-negative breast cancer.