The Nordic SentiMag trial: a comparison of super paramagnetic iron oxide (SPIO) nanoparticles versus Tc(99) and patent blue in the detection of sentinel node (SN) in patients with breast cancer and a meta-analysis of earlier studies

• Published in: Breast cancer research and treatment 2016-06, Vol.157 (2), p.281-294
• Main Authors: Karakatsanis, Andreas, Christiansen, Peer Michael, Fischer, Lone, Hedin, Christina, Pistioli, Lida, Sund, Malin, Rasmussen, Nils Ryegaard, Jørnsgård, Hjørdis, Tegnelius, Daniel, Eriksson, Staffan, Daskalakis, Kosmas, Wärnberg, Fredrik, Markopoulos, Christos J, Bergkvist, Leif
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Coloring Agents - administration & dosage; Denmark; Female; Ferric Compounds - administration & dosage; Humans; Magnetite Nanoparticles; Middle Aged; Prospective Studies; Radiopharmaceuticals - administration & dosage; Rosaniline Dyes - administration & dosage; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node Biopsy - methods; Sentinel node; Super paramagnetic iron oxide; Sweden; Technetium Tc 99m Aggregated Albumin - administration & dosage
• ISSN: 1573-7217; 0167-6806; 1573-7217
• DOI: 10.1007/s10549-016-3809-9

The aim of the study is to compare the efficacy of SPIO as a tracer in sentinel node biopsy (SNB) in breast cancer with Tc and patent blue in a multicentre prospective study and perform a meta-analysis of all published studies. It also aims to follow skin discoloration after SPIO injection and describe when and how it resolves. Totally 206 patients with early breast cancer were recruited. Tc and patent blue were administered in standard fashion. Patients were injected with SPIO (Sienna+) preoperatively. SNB was performed and detection rates were recorded for both methods. Skin discoloration was followed and documented postoperatively. Data extraction and subsequent meta-analysis of all previous studies were also performed. SN detection rates were similar between standard technique succeeded and SPIO both per patient (97.1 vs. 97.6 %, p = 0.76) as well as per node (91.3 vs. 93.3 %, p = 0.34), something which was not affected by the presence of malignancy. Concordance rates were also consistently high (98.0 % per patient and 95.9 % per node). Discoloring was present in 35.5 % of patients postoperatively, almost exclusively in breast conservation. It fades slowly and is still detectable in 8.6 % of patients after 15 months. Meta-analysis depicted similar detection rates (p = 0.71) and concordance rates (p = 0.82) per patient. However, it seems that SPIO is characterized by higher nodal retrieval (p