Abstract PO4-27-10: A Systematic Review and Meta-analysis of Diagnostic Performance of Fluorescein Guided Sentinel Lymph Node Biopsy in Early Breast Cancer
Authors: Yadav Sanjay Kumar , S Bharath , Khadka Sarada , Sharma Dhananjaya , Jha Chandan Kumar , Agarwal Gaurav , Singh Manju , Srivastava Anurag , Goyal Amit 
Published: May 2024

Background: Evaluation 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. There is a paucity of radioactive tracer in many countries of transitional economies. Hence, alternatives to isotope have been explored, viz. indocyanine green (ICG), superparamagnetic iron oxide nanoparticles and Fluorescein Sodium (FS). This systematic review and meta-analysis, evaluates the diagnostic performance of Fluorescein Sodium guided SLNB. Objectives: The objective was to evaluate the diagnostic performance of Fluorescein Sodium for sentinel lymph node biopsy in early breast cancer. Methods: PRISMA 2020 guidelines were followed for this meta-analysis. Eligibility criteria: Studies where SLNB was performed using Fluorescein Sodium for breast carcinoma. 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 detection rate and pooled false negative rate using random effects model. In order to describe heterogeneity, we constructed summary receiver operating characteristic (SROC) curves with 95% prediction regions, estimated using bivariate meta-analysis with a test level random effect only, and forest plots. Calculations were performed using the Meta-Disc v1.4 program (available from https://metadisc.software.informer.com/1.4/). Results: Out of 45 studies found on initial systematic search, 7 studies were found eligible and were included in the meta-analysis based on data on 332 patients. The pooled detection rate was 93.2% (95% confidence interval [CI] 87% to 97%).). The heterogeneity (I2 value) of the pooled detection rate was 71%. Five validation studies were included for pooling the false negative rate (FNR) and included a total of 211 patients. The pooled FNR was 5.6% (95% CI; 2.9 to 9.07). Five validation studies were included for sensitivity, specificity, diagnostic odds ratio, LR+ and LR- meta-analysis. With regards to the identification of SLN the pooled sensitivity was 80% [(95% CI, 68% to 89%); I2=79.8]; specificity was 98% [(95% CI, 95% to 100%); I2=0.0]. The likelihood ratio for a positive test LR+ was 23.2 [(95% CI, 5.91 to 95.18); I2=0.0] and likelihood ratio for a negative test a LR- of 0.41 [(95% CI, 0.16 to 1.05); I2=88.1]. The diagnostic Odds ratio OR was 76.94 (95% CI, 15.88 to 372.79). Diagnostic accuracy as measured by SROC was 99.08%. Q index was 0.96. Publication bias for pooled detection rate as per Egger’s test was -2.2 (p= 0.66) and for FNR was 1.85 (p=0.29). Visual inspection of summary ROC curve and of forest plots did not show significant heterogeneity. Conclusion: Fluorescein guided SLNB is an affordable option for detection of lymph node metastases in cN0 patients with early breast cancer. It achieves a high detection rate of 93% with a false negative rate of 5.6% for the detection of axillary lymph node metastasis. We recommend larger multinational trials to confirm its high detection rate with low false negativity.

Citation Format: Sanjay Kumar Yadav, Bharath S, Sarada Khadka, Dhananjaya Sharma, Chandan Kumar Jha, Gaurav Agarwal, Manju Singh, Anurag Srivastava, Amit Goyal. A Systematic Review and Meta-analysis of Diagnostic Performance of Fluorescein Guided Sentinel Lymph Node Biopsy in Early Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-10.