Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis

Background: In early-stage breast cancer, indocyanine green (ICG)-fluorescence based sentinel lymph node (SLN) detection is being considered. This is a meta-analysis of SLN detection rates and sensitivity of ICG-fluorescence compared to radioisotope (RI), to evaluate its clinical applicability. Data sources: Systematic review of full-text articles from PubMed and Scopus, of women with early breast cancer who underwent SLN mapping using ICG and RI concurrently was performed. The metaanalysis was performed using the Mantel-Haenszel method. Results: 2301 patients from 19 studies were included. No significant difference was observed between ICG and RI for SLN detection (OR0.90,95%Cl0.66-1.24) or sensitivity (OR1.23,95%Cl0.73-2.05) with heterogeneity between studies (I-2 = 58%,P = 0.003). Sensitivity of dual mapping (ICG + RI) was significantly better compared to single mapping with RI (OR3.69,95%Cl1.79-7.62) or ICG (OR3.32,95%Cl1.52-7.24) alone with no heterogeneity between studies (I-2 = 0%,P = 0.004). Conclusion: ICG-fluorescence could complement RI method or provide alternative in centers with poor accessibility to RI lymphoscintigraphy. (C) 2020 Elsevier Inc. All rights reserved.