title: Indocyanine green fluorescence-guided sentinel node biopsy: a meta-analysis on detection rate and diagnostic performance.
abstract: BACKGROUND
  Indocyanine green (ICG) fluorescence-guided sentinel node biopsy (SLNB) has been successfully employed in various kinds of tumors. Clinical results of previous studies on this technique are at different levels of evidence. This Meta-analysis was conducted to provide a more precise estimation on its clinical performance.
  
  
  METHODS
  Eligible studies were identified from systematical PubMed and EMBASE searches; data were extracted. A Meta-analysis was performed to generate pooled detection rate, sensitivity, specificity, diagnostic odds ratio (DOR) and summary receiver operator characteristic curves.
  
  
  RESULTS
  Fifteen published articles were included. Clinical data of 513 patients were obtained. The pooled detection rate, the pooled sensitivity, the pooled specificity, the pooled DOR and their 95% confidence intervals (95% CI) were 0.96 (0.91-0.99), 0.87 (0.79-0.92), 1.00 (0.99-1.00) and 150.13 (57.42-392.56), respectively. Significant heterogeneities existed among studies. Significant publication bias was found in detection rate. The concentration < 5 mg/ml subgroup and the injected volume ≥2 ml subgroup had higher DORs, sensitivities and detection rates than the concentration ≥ 5 mg/ml subgroup and the injected volume <2 ml subgroup, respectively.
  
  
  CONCLUSIONS
  Based on this Meta-analysis, this technique could be valued promising for detecting the presence of LN metastases. ICG injection with reduced concentration and larger volume may provide improved performance.
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Gazyakan
authors.affiliation: Eberhard-Karls-University Tübingen, BG Trauma Center Tübingen, Siegfried Weller Institut, Schnarrenbergstr. 95, 72076 Tübingen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Engel
authors.affiliation: Department of General, Visceral and Oncological Surgery, Helios Hospital Berlin-Buch, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hünerbein
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kneser
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany. Electronic address: christoph.hirche@bgu-ludwigshafen.de.
authors.forename: C
authors.initials: C
authors.lastname: Hirche
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D016001:Confidence Intervals; D005260:Female; D005453:Fluorescence; D005456:Fluorescent Dyes; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D061206:Neoplasm Micrometastasis / Q000473:pathology; D016017:Odds Ratio; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: Breast cancer; Colon cancer; Indocyanine green; Meta-analysis; Sentinel node biopsy