吲哚菁绿联合亚甲蓝在早期乳腺癌前哨淋巴结活检中应用的荟萃分析

Application of the combination of indocyanine green and methylene blue in sentinel lymph node biopsy of early-stage breast carcinoma: A Meta-analysis

目的 评价吲哚菁绿(indocyanine green, ICG)联合亚甲蓝(methylene blue, MB)在早期乳腺癌前哨淋巴结活检(sentinel lymph node biopsy, SLNB)中的临床应用价值。方法 检索2000年1月1日-2021年5月15日已公开发表在中国生物医学文献数据库、中国知网、万方数据库、维普数据库、PubMed、EMBASE、Web of Science及Cochrane Library有关ICG联合MB在早期乳腺癌SLNB中应用的临床研究。荟萃分析比较不同方法之间病人检出率(identification rate, IR)、假阴性率(false negative rate, FNR)、特异度、准确度的差异。借助Egger检验评估文献发表偏倚。结果 本次荟萃分析共计纳入21篇文献(4 813例病人),结果显示,对比单用MB,ICG联合MB的IR(OR=7.19,CI=5.23-9.87,P<0.001)、特异度(OR=4.18,95%CI=1.78-9.83,P<0.001)及准确度(OR=4.60,95%CI=2.10-10.11,P<0.001)均明显提高,而FNR则明显降低(OR=0.22,95%CI=0.13-0.37,P<0.001)。结论 ICG联合MB较之单用MB优势明显。

Objective To systematically evaluate the application value of the combination of indocyanine green(ICG) and methylene blue(MB) in sentinel lymph node biopsy(SLNB) of early-stage breast carcinoma(EBC).Methods A literature search was performed using CBM,CNKI,WanFang databases, VIP,PubMed, Embase, Web of Science and Cochrane Library to identify papers published from January 1,2000 to May 15,2021 to research the application value of the combination of ICG and MB in SLNB of EBC.The literature was screened according to inclusion and exclusion criteria.Relevant data were extracted, and a quality assessment was conducted.The meta-analysis was used to disclose the differences in identification rate(IR) of patients, the false negative rate(FNR),specificity and accuracy between the above methods.Egger test was used to evaluate the publication bias.Results A total of 21 studies with 4 813 patients were included in this Meta-analysis.The results showed that the IR of patients(OR=7.19,CI=5.23-9.87,P<0.001),specificity(OR=4.18,95%CI=1.78-9.83,P<0.001),accuracy(OR=4.60,95%CI=2.10-10.11,P<0.001) was obviously increased and the FNR(OR=0.22,95%CI=0.13-0.37,P<0.001) was significantly decreased by using ICG plus MB compared with MB alone.Conclusion Compared with MB alone, ICG with MB enjoys a significant advantage.It expects to offer innovative approaches in SLNB of EBC.