Comparisons Of ICG-fluorescence With Blue Dye And Radioisotope In Sentinel Lymph Node Biopsy For Early-stage Breast Cancer Patients:a Meta-analysis

Objective:Radioisotopes(RI)and blue dye(BD)are the routinely used markers for staining.The aim of this meta-analysis is to compare the clinical utility of indocyanine green(ICG)and conventional tracers and to confirm whether ICG can act as a better tracer than those conventional techniques.Methods:Twenty-one studies were selected from PubMed,EMBASE and The Cochrane Library,all the studies were classified into three groups:the ICG versus BD group,the ICG versus RI group and the ICG versus BD combined RI group.Each group was judged based on four endpoints:the identification rate(IR)of the patients,the IR of the sentinel lymph nodes(SLNs),the IR of the positive SLNs and the false negative rate.Results:Compared with BD,ICG is superior in terms of the IR of the patients(OR=7.17,95%CI 3.98-12.94),the IR of the SLNs(OR=8.84,95%CI 6.71-11.66)and FNR(OR=0.20,95%CI 0.08-0.48)using a fixed-effects model.There is a significant difference in both the IR of the positive SLNs(OR=21.32,95%CI 2.84-160.14)and FNR(OR=0.46,95%CI 0.23-0.91)in the ICG versus RI group.In the subgroup analysis of the ICG versus RI group by the dose of ICG,there is a difference in the IR of the patients(OR=1.77,95%CI 1.09-2.85)and the IR of the SLNs(OR=21.62,95%CI 5.23-89.43)using a fixed-effects model when ICG is used at a standard dose.In the ICG versus BD and RI group,there were no differences in the endpoints of the IR of the patients or the IR of SLNs respectively.Conclusion:ICG can act as a better tracer than can BD or RI and not a worse tracer than the combination of BD and RI is.It could be a good replacement for conventional tracers clinically.