Table 1.
Main characteristics of eligible studies.
| First Author | Study Design | Country | Procedures (N) | Mapping Material | Identification Rate of ARM Nodes or Lymphatics | SLN-ARM Crossover Rate | Metastatic Rate of ARM Nodes | Lymphedema Incidence | Follow-Up Duration | Study Quality | Study Period |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Nos et al. (2007) [ 27] | Prospective | France | ALND alone (21) | Blue dye | ALND: 71%(15/21) | NA | 0%(0/10) | NA | NA | Moderate quality | November 2004–February 2005 |
| Nos et al. (2008) [28] | Prospective | France | ALND alone (23) | Blue dye + radioisotope | ALND: 91%(21/23) | NA | 14%(3/21) | NA | NA | Moderate quality | July 2006–March 2008 |
| Casabona et al. (2009) [23] | Prospective | Italy | SLNB with or without ALND (72); ALND + SLNB (9) |
Blue dye | SLND: 38%(27/72) ALND: 89%(8/9) |
0%(0/72) | 0%(0/3) | NA | 9 months | Moderate quality | January 2007–July 2008 |
| Ponzone et al. (2009) [29] | Prospective | Italy | ALND alone (49) | Blue dye | ALND: 55%(27/49) | NA | 11%(3/27) | NA | NA | Moderate quality | June 2007–December 2008 |
| Bedrosian et al. (2010) [30] | Prospective | USA | ALND alone (30) | Blue dye | ALND: 50%(15/30) | NA | 13%(2/15) | NA | NA | Moderate quality | May 2008–January 2009 |
| Deng et al. (2011) [9] | Prospective | China | SLNB alone (69) | Blue dye | NA | 28%(19/69) | 9%(6/69) | NA | NA | Moderate quality | October 2009–August 2010 |
| Han et al. (2012) [14] | Prospective | Korea | SLNB with or without ALND (97); ALND with SLNB (83) |
Blue dye | SLND: 71%(10/14) ALND: 84%(70/83) |
7%(7/97) | 12%(2/17) | SLNB: 0%(0/14) SLNB + ALND: 1%(1/83) |
9.6 months | Moderate quality | January 2009–October 2010 |
| Rubio et al. (2012) [25] | Prospective | Spain | SLNB with ALND (15); ALND with or without SLNB (36) |
Blue dye | ALND: 83%(30/36) | 14%(2/14) | 13%(4/30) | NA | 20 months | Moderate quality | July 2009–May 2010 |
| Connor et al. (2013) [11] | Prospective | USA | SLNB alone (155); ALND with or without SLNB (57) |
Blue dye | SLND: 47%(73/155) ALND: 72(41/57) |
11%(22/197) SLNB:18/155 ALND:4/42 |
8%(3/37) | SLNB: 4%(6/137) | 12 months | Moderate quality | December 2009–02/2012 |
| Gennaro et al. (2013) [16] | Prospective | Italy | ALND (15); selective axillary dissection (45) | Radioisotope | ALND: 75%(45/60) | NA | NA | ALND: 15%(9/60) | 16 months | Moderate quality | June 2009–February 2012 |
| Tausch et al. (2013) [8] | Prospective | Switzerland | ALND alone (143) | Blue dye + radioisotope | ALND: 78%(112/143) | NA | 15%(17/115) | ALND: 31%(35/114) | 19 months | Moderate quality | April 2009–April 2012 |
| Ikeda et al. (2014) [17] | Prospective | Japan | ALND with or without SLNB (98) | Fluorescence | ALND: 82%(80/98) | NA | 22%(17/76) | ALND: 28%(13/47) SLNB + ALND: 22%(11/51) |
24 months | High quality | January 2010–December 2012 |
| Khandelwal et al. (2014) [31] | Prospective | India | ALND alone (51) | Blue dye | ALND: 88%(45/51) | NA | 27%(12/45) | NA | NA | Moderate quality | May 2011–May 2013 |
| Kuusk et al. (2014) [15] | Prospective | Canada | SLNB alone (37); ALND alone (15) |
Blue dye | SLND: 19%(7/37) ALND: 47%(7/15) |
8%(4/52) SLNB:5%(2/37) ALND:2/15 |
7%(1/15) | SLNB + ALND: 2%(1/47) | 24 months | Moderate quality | July 2010–November 2012 |
| Ochoa et al. (2014) [18] | Prospective | USA | SLNB alone (237); ALND with or without SLNB (123) |
Blue dye | SLND: 34%(80/237) ALND: 76%(93/123) |
4%(15/348) | 19%(5/27) | SLNB: 2%(4/237) SLNB + ALND: 2% (3/123) |
12 months | Moderate quality | 05/2006–10/2011 |
| Sakurai et al. (2014) [19] | Prospective | Japan | SLNB alone (321) | Blue dye + fluorescence | SLND: 32%(120/372) | 21%(77/372) | NA | SLNB: 2%(5/321) | 12 months | Moderate quality | 08/2009–07/2012 |
| Schunemann et al. (2014) [7] | Prospective | Brazil | ALND alone (45) | Blue dye | ALND: 89%(40/45) | NA | 25%(10/40) | NA | NA | Moderate quality | 01/2010–10/2012 |
| Beek et al. (2015) [32] | Prospective | Netherlands | ALND alone (112) | Blue dye | ALND: 88%(98/112) | NA | 20%(20/98) | NA | NA | High quality | 10/2009–11/2013 |
| Yue et al. (2015) [20] | RCT | China | ALND alone (127); ALND + ARM (138) |
Blue dye + radioisotope | ALND: 93%(129/138) | NA | 9%(11/129) | ALND: 21%(51/245) | 20 months | High quality | 01/2012–03/2014 |
| Gandhi et al. (2016) [33] | Prospective | India | ALND alone (50) | Radioisotope | ALND: 94%(47/50) | NA | 11%(5/47) | NA | NA | Moderate quality | 04/2012–08/2012 |
| Ngui et al. (2016) [26] | Prospective | Australia | ALND alone (87) | Blue dye | ALND: 77%(67/87) | 9%(3/32) | 27%(18/67) | NA | NA | Moderate quality | 06/2012–12/2014 |
| Noguchi et al. (2016) [2] | Prospective | Japan | SLNB with or without ALND(292); ALND with SLNB (48) |
Blue dye + fluorescence | SLND: 31% (90/292) ALND: 86%(36/42) |
27%(77/286) | 21%(19/90) | SLNB: 1%(2/244) | 45 months | Moderate quality | 06/2012–12/2014 |
| Nos et al. (2016) [34] | Prospective | France | ALND alone (172) | Radioisotope | ALND: 100%(172/172) | NA | 31%(54/172) | SLNB + ALND: 27% | 34 months | Moderate quality | 12/2009–12/2012 |
| Kumar et al. (2017) [35] | Prospective | India | ALND alone (20) | Blue dye | ALND: 75%(15/20) | NA | 13%(2/15) | NA | NA | Moderate quality | 05/2014–07/2015 |
| Tummel et al. (2017) [6] | Prospective | USA | SLND alone (472), ALND with or without SLNB (213) | Blue dye + radioisotope | SLND: 29%(138/472) ALND: 72%(153/213) |
4%(18/472) | 8%(7/74) | SLNB: 3%(12/350) ALND: 21%(33/154) |
26 months | Moderate quality | 06/2007–12/2013 |
| Faisal et al. (2019) [22] | RCT | Egypt | ALND alone (24); ALND + ARM (24) | Blue dye | ALND: 83%(20/24) | NA | 0%(0/4) | ALND: 10%(5/48) | 6 months | High quality | 06/2017–01/2018 |
| Ma et al. (2019) [24] | Prospective | China | ALND with SLNB (44) | Blue dye + fluorescence | SLNB: 29/44(66%) ALND: 96%(44/46) |
11%(5/44) | 16%(7/44) | NA | NA | Moderate quality | 02/2017–10/2017 |
| Yuan et al. (2019) [21] | RCT | China | ALND alone (665); ALND + ARM (689) | Blue dye + fluorescence | ALND: 81%(558/689) | NA | 7%(38/558) | ALND: 10%(117/1191) | 37 months | High quality | 02/2013–10/2017 |
| Beek et al. (2020) [1] | RCT | Netherlands | ALND alone (46); ALND + ARM (48) | Blue dye | ALND: 78%(73/94) | NA | 3%(1/35) | ALND: 27% (18/66) | 24 months | High quality | 06/2013–08/2016 |
RCT randomized controlled trial; SLN sentinel lymph node; SLNB sentinel lymph node biopsy; ARM axillary reverse mapping; ALND axillary lymph node dissection; NA not applicable.