Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review

Lancet Oncol. 2014 Jul;15(8):e351-62. doi: 10.1016/S1470-2045(13)70590-4.


The existing standard for axillary lymph node staging in breast cancer patients with a clinically and radiologically normal axilla is sentinel lymph node biopsy with a radioisotope and blue dye (dual technique). The dependence on radioisotopes means that uptake of the procedure is limited to only about 60% of eligible patients in developed countries and is negligible elsewhere. We did a systematic review to assess three techniques for sentinel lymph node biopsy that are not radioisotope dependent or that refine the existing method: indocyanine green fluorescence, contrast-enhanced ultrasound using microbubbles, and superparamagnetic iron oxide nanoparticles. Our systematic review suggested that these new methods for sentinel lymph node biopsy have clinical potential but give high levels of false-negative results. We could not identify any technique that challenged the existing standard procedure. Further assessment of these techniques against the standard dual technique in randomised trials is needed.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Axilla
  • Breast Neoplasms / pathology*
  • Coloring Agents
  • Contrast Media
  • Female
  • Fluorescence
  • Humans
  • Indocyanine Green
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology*
  • Magnetite Nanoparticles
  • Microbubbles
  • Neoplasm Staging
  • Sentinel Lymph Node Biopsy / methods*
  • Ultrasonography


  • Coloring Agents
  • Contrast Media
  • Magnetite Nanoparticles
  • Indocyanine Green