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

BackgroundEvaluation 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.ObjectivesThe objective was to evaluate the diagnostic performance of FS for sentinel lymph node biopsy.MethodsEligibility 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.MethodsEligibility 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.MethodsEligibility 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.MethodsEligibility 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.ResultsA 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).ConclusionFluorescein-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.