Axillary sentinel lymph node identification using superparamagnetic iron oxide versus radioisotope in early stage breast cancer: The UK SentiMag trial (SMART study)

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

“…The generally administered doses of SPIO were 0.5 mL [ 24 , 32 ], 1.0 mL [ 31 , 34 ], 1.5 mL [ 34 ], and 2.0 mL [ 7 , 12 , 14 , 21 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 33 , 35 , 36 ] for clinical usage, usually diluted with saline and administered through subcutaneous injection into the peritumoral [ 32 ], intratumoral [ 24 ], or periareolar or subareolar zones [ 7 , 12 , 14 , 21 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The optimal time for administration of this agent was at least 20 min ahead of the axillary surgery [ 7 , 12 , 14 , 21 , 23 , 25 , 27 , 29 , 30 , 32 , 33 , 34 ,…”

“…For the standard studies, a radiolabeled tracer (with or without BD) was administered in accordance with each center’s protocol, with no technique or dose difference in the radioisotope between centers. Among these, 13 studies were additionally administered with BD [ 7 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 33 , 34 , 36 ], and the details of the tracer and method of injection were provided in all studies ( Table 2 ).…”

“…During surgery, the surgeon used the handheld magnetometer for skin localization of the sentinel lymph node, which was followed by a gamma probe to confirm the position. Among them, thirteen studies used the magnetometer with a combination of standard techniques for in vivo confirmation [ 14 , 21 , 25 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 36 ]. Six studies used the standard technique only after SLNB was performed with the magnetometer, as well as for ex vivo verification.…”

“…Six studies had performed lymphoscintigraphy before SLNB [ 14 , 21 , 23 , 28 , 29 , 33 ]. Eleven studies did not report whether lymphoscintigraphy had been taken [ 7 , 12 , 21 , 24 , 25 , 30 , 31 , 32 , 34 , 35 , 36 ], while the remaining studies did not take lymphoscintigraphy routinely [ 26 , 27 ]. Of note, two studies which blinded the surgeons when executing the lymphoscintigraphy were later resolved by the introduction of the magnetic technique [ 23 , 28 ].…”

“…A total of 19 studies were included when analyzing the outcome of the patient detection rate [ 7 , 12 , 14 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. After our pooled meta-analysis with a fixed-effects model, no significant differences were revealed in patient detection rates between the SPIO and standard method group (RR, 1.00; 95% CI, 0.99–1.01; I 2 = 20%; p = 0.21) ( Figure 2 ).…”