Flow chart for the selection of the included studies.

<p>Flow chart for the selection of the included studies.</p

Diagnostic Performance of Indocyanine Green-Guided Sentinel Lymph Node Biopsy in Breast Cancer: A Meta-Analysis

<div><p>Background</p><p>The diagnostic performance of indocyanine green (ICG) fluorescence-guided sentinel lymph node biopsy (SLNB) for the presence of metastases in breast cancer remains unclear.</p><p>Objective</p><p>We performed a meta-analysis to investigate the diagnostic performance of ICG-guided SLNB.</p><p>Methods</p><p>Eligible studies were identified from searches of the databases PubMed and EMBASE up to September 2015. Studies that reported the detection rate of ICG fluorescence-guided SLNB with full axillary lymph node dissection and histological or immunohistochemical examinations were included. A meta-analysis was performed to generate pooled detection rate, sensitivity, specificity, false negative rate, diagnostic odds ratio (DOR) and a summary receiver operator characteristic curve (SROC).</p><p>Results</p><p>Nineteen published studies were included to generate a pooled detection rate, comprising 2594 patients. The pooled detection rate was 0.98 (95% confidence interval [CI], 0.96–0.99). Six studies finally met the criteria for meta-analysis, which yielded a pooled sensitivity of 0.92 (95% CI, 0.85–0.96), specificity 1 (95% CI, 0.97–1), and DOR 311.47 (95% CI, 84.11–1153.39). The area under the SROC was 0.9758. No publication bias was found.</p><p>Conclusion</p><p>ICG fluorescence-guided SLNB is viable for detection of lymph node metastases in breast cancer. Large-scale randomized multi-center trials are necessary to confirm our results.</p></div

Nineteen studies of the pooled detection rate analysis.

<p>Nineteen studies of the pooled detection rate analysis.</p

Nineteen studies for the pooled detection rate analysis.

<p>Nineteen studies for the pooled detection rate analysis.</p

Summary of receiver operator characteristic curves.

<p>Summary of receiver operator characteristic curves.</p

The pooled DOR was 311.47 (95% CI, 84.11–1153.39).

<p>The pooled DOR was 311.47 (95% CI, 84.11–1153.39).</p

The pooled detection rates was 0.98 (95% confidence interval [CI], 0.96–0.99).

<p>The pooled detection rates was 0.98 (95% confidence interval [CI], 0.96–0.99).</p

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

<div><p>Objectives</p><p>The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.</p><p>Methods</p><p>Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.</p><p>Results</p><p>Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.</p><p>Conclusions</p><p>The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.</p><p>Trial Registration</p><p>ClinicalTrial.gov <a href="https://clinicaltrials.gov/ct2/show/NCT00418457" target="_blank">NCT00418457</a></p></div

Ultrasound image of thoracic transverse process.

<p>Transverse processes (TP) appear square and lie deeper than the ribs. The distance between the skin and the TP was measured and 5 mm added (distance A). The distance between the skin and the pleura was also measured (distance B). Distance A was used as the reference for needle depth, and the needle was not advanced beyond distance B.</p

Comparison of randomized groups (PPA vs. GA) on primary outcome variables (N = 247).

<p>^ 98.75% confidence intervals to maintain overall 0.025 significance level: one-tailed testing for superiority for four outcomes with one-tailed alpha of 0.00625 for each outcome.</p><p>* P-values from one-sided Wilcoxon rank sum test; Bonferroni multiplicity correction [i.e., significance criterion P <0.025/4 = 0.00625; thus, all are significant].</p><p>** Note: sevoflurane was administered to 2% of regional and 99% of general anesthesia patients (relative risk, 0.02; 98.75% CI, 0.001 to 0.1).</p><p># Mean ranks: values for an outcome variable were first ordered from smallest to largest across all patients, and the ordering for a particular patient was considered as the “rank” for that outcome (i.e., there were a total of 121 + 126 = 247 ranks). The ranks were then averaged within each randomized group and the ratio of those means reported as “ratio of mean ranks”. Confidence intervals were obtained by bootstrap resampling.</p><p>Abbreviations: PPA, propofol and paravertebral block anesthesia; GA, general anesthesia; CI, confidence interval; MAC, minimum alveolar concentration. VAS = 10-cm visual analog scale. Morphine equivalents were calculated from long-acting opioids given intraoperatively or postoperatively, but excluded intraoperative fentanyl, which is reported separately. Results presented as median [first, third quartiles], median difference and ratio of mean ranks (98.75% confidence interval).</p