Meta-analysis of sentinel lymph node biopsy in breast cancer using the magnetic technique

Zada, A; Peek, M; Muneer, A; Bauke, A; Baker, RD; Kusakabe, M; Sekino, M; Klaase, JM; ten Haken, B; Douek, M

Abstract

Background
3 The gold standard for sentinel lymph node biopsy (SLNB), the dual technique (radiolabelled tracer and
4 blue dye), has several drawbacks. A novel magnetic technique without these drawbacks, has been
5 evaluated in a number of clinical trials. It utilizes a magnetic tracer and a hand-held magnetometer to
6 identify and excise sentinel lymph nodes (SLNs). A systematic review and meta-analysis was performed
7 to assess the performance and utility of magnetic in comparison to the standard technique.
8 Method
9 Medline, PubMed, Embase and the Cochrane online literature databases were used to identify all
10 original articles published up to April 2016, evaluating the magnetic technique for SLNB. Studies were
11 included if they were prospectively conducted clinical trials comparing magnetic to standard technique
12 for SLNB in patients with breast cancer.
13 Results
14 Seven studies were included and magnetic technique was non-inferior to standard technique (z=3.87,
15 p<0.001), at a 2% non-inferiority margin. The mean identification rates for standard and magnetic
16 technique were 96.8% (94.2-99.0%) and 97.1% (94.4-98.0%) respectively (p=0.690, RD 0.0, 95% CI [-
17 0.01-0.01]). The total lymph node retrieval (LNR) was significantly higher with magnetic compared to
18 standard technique (2,113 (1.9 per patient) versus 2,000 (1.8 per patient); p=0.003, RD 0.05, 95% CI
19 [0.03-0.06]). False-negative rates were 10.9% (5.6-22.3%) for standard technique and 8.4% (1.6-22.3%)
20 for magnetic technique (p=0.551, RD 0.03; 95% CI [0.00-0.06]). The mean discordance rate was 3.9%
21 (1.7-6.9%).
22 Conclusion
23 The magnetic technique for SLNB is non-inferior to standard technique, with a high identification rate
24 but with a significantly higher lymph node retrieval rate.

Citation

Zada, A., Peek, M., Muneer, A., Bauke, A., Baker, R., Kusakabe, M., …Douek, M. (2016). Meta-analysis of sentinel lymph node biopsy in breast cancer using the magnetic technique. British Journal of Surgery, 103(11), 1409-1419. https://doi.org/10.1002/bjs.10283

• Journal Article Type: Article
• Acceptance Date: Jun 30, 2016
• Online Publication Date: Sep 9, 2016
• Publication Date: Sep 9, 2016
• Deposit Date: Jan 31, 2017
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Publisher: Wiley
• Volume: 103
• Issue: 11
• Pages: 1409-1419
• DOI: https://doi.org/10.1002/bjs.10283
• Publisher URL: http://dx.doi.org/10.1002/bjs.10283