Magnetic nanoparticle technique versus radioisotope technique in detection of sentinel lymph node in early breast cancer: a systematic review and meta-analysis

Muhammad Salman, Christina Macano, Rishabha D. Sharma, Alfonso Antequerra


Sentinel lymph node biopsy is the standard technique to stage the axilla in early breast cancer. The gold standard is the dual technique of radioisotope and blue dye injection. The drawbacks of dual technique include handling and disposal of radioactive material. Equally reliable, user and patient friendly, magnetic tracer super paramagnetic iron oxide, was compared with the radioisotope tracer in detection of Sentinel lymph node in a clinically node negative axilla in early breast cancer in this meta-analysis, with emphasis on the utility and safety of both techniques. PubMed, Medline were searched from April 2015 to October 2019. 1395 patients’ data was included from seven homogenous studies in this meta-analysis. A statistical analysis was performed using STATA 16.1 version for sentinel lymph node detection rate using standard technique, magnetic tracer technique and both techniques. Ratio of successes and failures of the outcomes was measured and analysed. A paired two sample ‘Z’ test was performed to compare between the standard technique and magnetic tracer techniques. The standardised mean difference of ratio of success rate between two techniques was; 1.013334 with a p value of 0.3136.The standardised mean difference of ratio of failure rate between two techniques was 1.016667, with a p value of 0.3132. Success and failure rate showed statistically no significant difference between the two techniques. This two-way analysis with paired two sample ‘Z’ test confirms that neither standard technique nor magnetic tracer techniques are superior or inferior to each other.


Breast neoplasm, Sentinel lymph node, Super paramagnetic iron oxide, Sienna, SentiMAG, Radio isotope Tc99

Full Text:



Alvardo M, Mittendorf E, Teshome M. Sentimag IC: A Non-inferiority trial comparing superparamagnetic iron oxide versus technetium-99m and blue dye in the detection of axillary sentinel nodes in patients with early-stage breast cancer. Ann Surg Oncol. 2019; 102(23):1456-9.

Karakatsanis A, Daskalakis K, Stalberg P. Superparamagnetic iron oxide nanoparticles as the sole method for sentinel lymph node biopsy detection in patients with breast cancer. Br J Surg. 2017; 104(12):1675-85.

Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicentre trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst. 2006; 98:599-609.

Straver ME, Meijnen P, van Tienhoven G, van de Velde CJH, Mansel RE, Bogaerts J, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol. 2010;17:1854-61.

Pouw JJ, Grootendorst MR, Bezooijen R, Klazen CAH, DeBruin WI, Klaase JM, et al. Preoperative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol. Br J Radiol. 2015;88:20150634.

Karakatsanis A, Christiansen PM, Fischer L, Hedin C, Pistioli L, Sund M, et al. The Nordic SentiMag Trial: a comparison of superparamagnetic iron oxide (SPIO) nanoparticles versus Tc99 and patent blue in the detection of sentinel node (SN) in patients with breast cancer and a meta-analysis of earlier studies. Breast Cancer Res Treat. 2016;157:281-94.

Montgomery LL, Thorne AC, Van Zee KJ, Fey J, Heerdt AS, Gemignani M, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg. 2002;95(2):385-8.

Taruno K, Kurita T, Kuwahata A. Multicentre clinical trial sentinel lymph node biopsy using superparamagnetic iron oxide nanoparticles and a novel handheld magnetic probe. J Surg Oncol. 2019; 1-6:59-67.

Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol. 2014; 15:e351-62.

Douek M, Klaase J, Monypenny I, Kothari A, Zechmeister K, Brown D, et al. Sentimag Trialists Group. Sentinel node biopsy using a magnetic tracer versus standard technique: The SentiMAG Multicentre Trial. Ann Surg Oncol. 2014;21:1237-45.

Thill M, Kurylcio A, Welter R, van Haasteren V, Grosse B, Berclaz G, et al. The Central European SentiMag study: sentinel lymph node biopsy with superparamagnetic iron oxide (SPIO) vs. radioisotope. Breast. 2014;23:175-9.

Rubio IT, Diaz-Botero S, Esgueva A, Rodriguez R, Cortadellas T, Cordoba O, et al. The superparamagnetic iron oxide is equivalent to the Tc99 radiotracer method for identifying the sentinel lymph node in breast cancer. Eur J Surg Oncol. 2015; 41:46-51.

Piñero-Madrona A, Torró-Richart JA, de León-Carrillo JM, de Castro-Parga G, NavarroCecilia J, Domínguez-Cunchillos F, et al. Superparamagnetic iron oxide as tracer for sentinel node biopsy in breast cancer: a comparative non-inferiority study. Eur J Surg Oncol. 2015;41:991-7.

Ghilli M, Carretta E, Di Filippo F, Battaglia C, Fustaino L, Galanou I, et al. The superparamagnetic iron oxide tracer: a valid alternative in sentinel node biopsy for breast cancer treatment. Eur J Cancer Care. 2017;26:e12385..

Houpeau JL, Chauvet MP, Guillemin F, Bendavid-Athias C, Charitansky H, Kramar A, et al. Sentinel lymph node identification using superparamagnetic iron oxide particles versus radioisotope: The French Sentimag feasibility trial. J Surg Oncol. 2016; 113:501-7.

Teshome M, Wei C, Hunt KK, Thompson A, Rodriguez K, Mittendorf EA. Use of a magnetic tracer for sentinel lymph node detection in early-stage breast cancer patients: a meta-analysis. Ann Surg Oncol. 2016;23:1508-14.

Somasundaram SK, Chicken DW, Keshtgar MR. Detection of the sentinel lymph node in breast cancer. Br Med Bull. 2007;84:117-31.

Miner TJ, Shriver CD, Flicek PR, Miner FC, Jaques DP, Maniscalco-Theberge ME, Krag DN. Guidelines for the safe use of radioactive materials during localization and resection of the sentinel lymph node. Ann Surg Oncol. 1999;6(1):75-82.

Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a meta-analysis. Cancer. 2006;106:4-16.