Yin Rui, Ding Lu-Yu, Wei Qing-Zhong, Zhou Ya, Tang Guang-Yuan, Zhu Xun
Department of General Surgery, Beijing Aerospace General Hospital, Beijing 100076, P.R. China.
Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China.
Oncol Lett. 2021 Feb;21(2):114. doi: 10.3892/ol.2020.12375. Epub 2020 Dec 15.
Radioisotopes (RI) and blue dye (BD) are routinely used markers for staining during sentinel lymph node biopsy (SLNB) in breast cancer. Compared with traditional tracers, tracer performance of indocyanine green (ICG) has been controversial. A total of 21 studies were selected from the PubMed, EMBASE and Cochrane Library databases. Detection ability was judged based on four endpoints: i) The identification rate (IR) of the patients; ii) the IR of the sentinel lymph nodes (SLNs); iii) the IR of the positive SLNs; and iv) the false negative rate (FNR). Compared with BD, ICG was superior in terms of the IR of the patients [odds ratio (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 was 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 vs. RI group. Furthermore, when using ICG at the recommended dose, a significant difference was found 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. In the ICG vs. BD combined with RI group, there were no differences in either the IR of the patients (OR=5.10; 95% CI, 0.24-107.48) or the IR of SLNs (OR=5.10; 95% CI, 0.60-256.66). In conclusion, ICG was a better tracer compared with BD or RI alone and was not a worse tracer compared with BD combined with RI. The use of the recommended dose of ICG had an improved tracer effect. ICG is expected to be widely used in SLNB in view of its clinical advantages.
放射性同位素（RI）和蓝色染料（BD）是乳腺癌前哨淋巴结活检（SLNB）中常规用于染色的标记物。与传统示踪剂相比，吲哚菁绿（ICG）的示踪性能一直存在争议。从PubMed、EMBASE和Cochrane图书馆数据库中总共筛选出21项研究。基于四个终点判断检测能力：i）患者的识别率（IR）；ii）前哨淋巴结（SLN）的IR；iii）阳性SLN的IR；以及iv）假阴性率（FNR）。与BD相比，使用固定效应模型时，ICG在患者IR方面更具优势[优势比（OR）=7.17；95%置信区间（CI），3.98 - 12.94]、SLN的IR方面（OR=8.84；95% CI，6.71 - 11.66）以及FNR方面（OR=0.20；95% CI，0.08 - 0.48）。ICG与RI组在阳性SLN的IR（OR=21.32；95% CI，2.84 - 160.14）和FNR（OR=0.46；95% CI，0.23 - 0.91）方面均存在显著差异。此外，当使用推荐剂量的ICG时，使用固定效应模型发现患者的IR（OR=1.77；95% CI，1.09 - 2.85）和SLN的IR（OR=21.62；95% CI，5.23 - 89.43）存在显著差异。在ICG与BD联合RI组中，患者的IR（OR=5.10；95% CI，0.24 - 107.48）或SLN的IR（OR=5.10；95% CI，0.60 - 256.66）均无差异。总之，与单独使用BD或RI相比，ICG是一种更好的示踪剂，与BD联合RI相比也并非更差的示踪剂。使用推荐剂量的ICG具有更好的示踪效果。鉴于其临床优势，ICG有望在SLNB中得到广泛应用。
