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

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.

Role of Nuclear Sentinel Lymph Node Mapping Compared to New Alternative Imaging Methods

“…The meta-analysis involved 2298 patients from 19 studies and demonstrated that the use of SPION led to 90.0% accuracy in locating sentinel lymph nodes, which was superior to the standard method’s 85.7%. Metastasis was confirmed in 639 sentinel lymph nodes, with corresponding rates of 96.7% for positive sentinel lymph node detected via SPION and 93.9% for those detected with a standard technique [ 17 ].…”

Iron and Cancer: A Special Issue

“…Taruno et al [ 9 ] demonstrate that the rate of SLN identification by super paramagnetic iron oxide (SPIO) nanoparticles is equivalent to a radioisotope tracer or dye, without provoking any significant side effects, such as allergic reactions, prolonged dermopigmentation, or MRI artifacts. A subsequent systemic review and meta-analysis revealed that SPIO nanoparticles could be considered an alternative standard for detecting SLN [ 10 ], indicative of advances being made in nanomedicine-based clinical applications.…”