A systematic review and meta-analysis of diagnostic performance of fluorescein-guided sentinel lymph node biopsy in early breast cancer

• Published in: Breast cancer research and treatment Vol. 206; no. 1; pp. 19 - 30
• Main Authors: Yadav, Sanjay Kumar, Bharath, S., Sharma, Dhananjaya, Srivastava, Anurag, Jha, Chandan Kumar, Agarwal, Gaurav, Khadka, Sarada, Singh, Manju, Shekhar, Saket, Goyal, Amit
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2024; Springer Nature B.V
• Subjects: Axilla; Biopsy; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Female; Fluorescein; Humans; Image-Guided Biopsy - methods; Lymph nodes; Lymphatic Metastasis - diagnosis; Lymphatic Metastasis - pathology; Lymphatic system; Medicine; Medicine & Public Health; Meta-analysis; Metastases; Oncology; Review; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy - methods; Systematic review; Systematic review; Fluorescein Sodium; Breast cancer; Sentinel lymph node biopsy; Meta-analysis
• ISSN: 0167-6806; 1573-7217; 1573-7217
• DOI: 10.1007/s10549-024-07310-0

Background
Evaluation of axillary lymph nodes status in cN0 axilla is performed by sentinel lymph node biopsy (SLNB) utilizing a combination of radioactive isotope and blue dye or alternative to isotope like Indocyanine green (ICG). Both are very resource-intensive; which has prompted development of low-cost technique of Fluorescein Sodium (FS)-guided SLNB. This systematic review and meta-analysis evaluate the diagnostic performance of FS-guided SLNB in early breast cancer.
Objectives
The objective was to evaluate the diagnostic performance of FS for sentinel lymph node biopsy.
Methods
Eligibility criteria
: Studies where SLNB was performed using FS.
Information sources:
PubMed, EMBASE, Cochrane library and online clinical trial registers.
Risk of bias:
Articles were assessed for risk of bias using the QUADAS-2 tool.
Synthesis of results:
The main summary measures were pooled Sentinel Lymph Node Identification Rate (SLN-IR) and pooled False Negative Rate (FNR) using random-effects model.
Results
A total of 45 articles were retrieved by the initial systematic search. 7 out of the 45 studies comprising a total of 332 patients were included in the meta-analysis. The pooled SLN-IR was 93.2% (95% confidence interval [CI], 0.87–0.97; 87% to 97%). Five validation studies were included for pooling the false negative rate and included a total of 211 patients. The pooled FNR was 5.6% (95% confidence interval [CI], 2.9–9.07).
Conclusion
Fluorescein-guided SLNB is a viable option for detection of lymph node metastases in clinically node negative patients with early breast cancer. It achieves a high pooled Sentinel Lymph Node Identification Rate (SLN-IR) of 93% with a false negative rate of 5.6% for the detection of axillary lymph node metastasis.