Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer: a meta-analysis

Abstract

Sentinel lymph node (SLN) biopsy using indocyanine green (ICG) fluorescence is safe and has a high detection rate for SLNs. However, the results of this novel technique are heterogeneous. The objective of this meta-analysis was to evaluate the diagnostic performance of the ICG fluorescence method compared with the standard radioisotope (RI) method. All eligible studies were identified from 2005 through 2015. A proportion meta-analysis was performed using a fixed effects and/or random effects model based on the study heterogeneity. A total of 12 studies met the inclusion criteria and included 1736 women. There was no significant difference between ICG fluorescence and RI for SLN detection using either the fixed effects model [odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87-1.90] or the random effects model (OR 1.32, 95% CI 0.54-3.18). There were seven studies reporting the detection rate for tumor-positive SLN. The ICG fluorescence method was significantly better than the RI method in the fixed effects model (OR 1.87, 95% CI 1.00-3.49) for staging axilla. However, there was no difference in the random effects model (OR 1.90, 95% CI 0.74-4.86). There was study outcome heterogeneity for the detection of SLN but not for tumor-positive SLN. There was no publication bias observed in the studies included. The ICG fluorescence method has valid diagnostic performance for SLN detection and shows a trend toward better axilla staging compared with the RI method. ICG fluorescence is a useful alternative to RI for SLN biopsy.

Sensitivity and specificity of indocyanine green near‐infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta‐analysis

“…ICG NIR fluorescence is primarily employed in CRC for assessment of the perfusion of the bowel ends prior to the anastomosis . ICG NIR fluorescence for SLN detection has been previously described with promising results for breast, endometrial and cervical, gastric, and pancreatic carcinoma . ICG NIR fluorescence can potentially help improve the oncologic outcome of surgery by florescent SLN mapping.…”

Shortwave infrared fluorescence imaging with the clinically approved near-infrared dye indocyanine green

“…Clinical imaging of ICG in the NIR has already shown value for angiography in ophthalmology, intraoperative assessment of blood vessel patency in tissue graft, bypass surgeries, and intracranial aneurism surgeries (1,5,(56)(57)(58)(59). Noninvasive imaging of lymphatic vasculature using ICG has also been described for surgical mapping and intraoperative identification of sentinel nodes, imaging nodes following surgical excision, and evaluation and monitoring of lymphedema (1,5,60,61). Increasingly, ICG fluorescence imaging is also being used in robot-assisted surgery, in which the surgeon relies on visual cues instead of tactile feedback (7,11,61).…”

New Technologies for Sentinel Lymph Node Detection

“…A review found that ICG is superior to blue dye in terms of sentinel node identification rate (fixed OR 18.37, 95% CI 8.63-39.10; p = 0.0001) and comparable to radioisotope (random OR 0.81; 95% CI 0.03-24.29; p = 0.90) [24]. A recent meta-analysis confirmed that the sentinel node detection rate is similar for ICG and radioisotope (fixed OR 1.29, 95% CI 0.87-1.90; random OR 1.32, 95% CI 0.54-3.18) [25]. More importantly, ICG and radioisotope were comparable for detection of tumour-positive sentinel node (random OR 1.90, 95% CI 0.74-4.86) [25].…”

“…A recent meta-analysis confirmed that the sentinel node detection rate is similar for ICG and radioisotope (fixed OR 1.29, 95% CI 0.87-1.90; random OR 1.32, 95% CI 0.54-3.18) [25]. More importantly, ICG and radioisotope were comparable for detection of tumour-positive sentinel node (random OR 1.90, 95% CI 0.74-4.86) [25]. ICG's smaller molecular size can result in faster migration in the lymphatics and identify more nodes (mean number of nodes excised 3-5.4 for ICG and 1-2.4 for blue dye) [24].…”