title: 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.
authors.affiliation: Department Surgery, Kansai Medical University, Hirakata, Japan. sugiet@hirakata.kmu.ac.jp.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Sugie
authors.affiliation: Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawaguchi
authors.affiliation: Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Toi
mesh_terms: D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Breast cancer; Fluorescence; Indocyanine green; Radioisotope; Sentinel lymph node