Liu Hong-Jin, Sun Ming-Shuai, Liu Li-Yuan, Yu Zheng-Heng, Chen Xiao-Xi, Liu Qian, Cheng Yuan-Jia, Xu Ling, Liu Yin-Hua, Ye Jing-Ming
Breast Disease Center, Peking University First Hospital, Beijing, China.
Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Transl Cancer Res. 2021 Dec;10(12):5222-5237. doi: 10.21037/tcr-21-1239.
Methylene blue (MB) alone or combined with 99mtechnetium-labeled sulphur colloid (Tc99m) or indocyanine green (ICG) is widely used for sentinel lymph node biopsy (SLNB) of early-stage breast cancer in developing countries and regions. However, studies investigating the effectiveness of MB combined with another tracer have produced heterogeneous results. The purpose of this network meta-analysis (NMA) was to evaluate the detection rate of MB alone, MB + Tc99m, and MB + ICG, and to examine the differences between the 3 methods.
We conducted a comprehensive electronic literature search on the PubMed, Embase, Web of Science, CNKI, and Wanfang Data databases from inception to October 2021. The meta-analysis included 7,498 patients in 49 studies. The risk of bias for each study was independently assessed as low, moderate, or high using criteria adapted from the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Fixed- and random-effects models were used to calculate pooled estimates. Mixed-comparison analysis using random-effects models. We assessed statistical heterogeneity by I2 statistics and evaluated publication bias using Begg's test.
The identification rate (IR), false-negative rate (FNR), sensitivity (SEN), and accuracy rate (AR) using MB + Tc99m were 96%, 7%, 93%, and 96%, respectively; the IR, FNR, SEN, and AR using MB + ICG were 97%, 7%, 93%, and 97%, respectively. The NMA found that IR and AR between MB + ICG and MB + Tc99m was OR =1.37 (95% CI: 0.41-4.20) and OR =1.33 (95% CI: 0.56-3.32), respectively.
Our results are similar to those of most previous studies, and meta-analysis showed that the MB + Tc99m or MB + ICG mapping methods can be used to obtain higher IR and lower FNR than MB alone. Our NMA showed no statistical significance between MB + Tc99m and MB + ICG with IR and AR. Both MB + Tc99m and MB + ICG can be used as effective mapping methods in SLNB of early-stage breast cancer to improve the detection rate.
在发展中国家和地区，亚甲蓝（MB）单独使用或与99m锝标记的硫胶体（Tc99m）或吲哚菁绿（ICG）联合使用，广泛用于早期乳腺癌前哨淋巴结活检（SLNB）。然而，关于MB与另一种示踪剂联合使用效果的研究结果并不一致。本网络荟萃分析（NMA）的目的是评估单独使用MB、MB + Tc99m和MB + ICG的检出率，并检验这三种方法之间的差异。
我们对PubMed、Embase、Web of Science、CNKI和万方数据数据库进行了全面的电子文献检索，检索时间从建库至2021年10月。荟萃分析纳入了49项研究中的7498例患者。使用改编自诊断准确性研究质量评估工具2（QUADAS - 2）的标准，将每项研究的偏倚风险独立评估为低、中或高。采用固定效应模型和随机效应模型计算合并估计值。使用随机效应模型进行混合比较分析。我们通过I²统计量评估统计异质性，并使用Begg检验评估发表偏倚。
使用MB + Tc99m时的识别率（IR）、假阴性率（FNR）、灵敏度（SEN）和准确率（AR）分别为96%、7%、93%和96%；使用MB + ICG时的IR、FNR、SEN和AR分别为97%、7%、93%和97%。NMA发现，MB + ICG与MB + Tc99m之间的IR和AR的比值比（OR）分别为1.37（95%置信区间：0.41 - 4.20）和1.33（95%置信区间：0.56 - 3.32）。
我们的结果与大多数先前研究的结果相似，荟萃分析表明，与单独使用MB相比，MB + Tc99m或MB + ICG映射方法可获得更高的IR和更低的FNR。我们的NMA显示，MB + Tc99m与MB + ICG在IR和AR方面无统计学意义。MB + Tc99m和MB + ICG均可作为早期乳腺癌SLNB的有效映射方法，以提高检出率。
