Sentinel lymph node biopsy in cervical cancer: A meta-analysis

Abstract

Abstract. Sentinel lymph node biopsy (SLNB) is used to determine the pathological status of the first lymph node receiving lymphatic drainage from the primary tumor. The diagnostic value of SLNB for the assessment of the nodal status in patients with cervical cancer has not been determined. Therefore, this meta-analysis was conducted to assess the diagnostic value of SLNB in cervical cancer. A search for related literature was performed using PubMed. Data were analyzed using a random effects model and a subgroup analysis was used to assess the diagnostic value of different practices during the process. A total of 17 studies involving a total of 1,112 patients were included in the analysis. The pooled sentinel lymph node (SLN) detection rate, sensitivity and negative predictive values were 92.2% [95% confidence interval (CI): 88.3-94.8%], 88.8% (95% CI: 85.1-91.7%) and 95.0% (95% CI: 92.8-96.6%), respectively. The subgroup analysis revealed that laparoscopy, tracer combination and immunohistochemistry were associated with a higher SLN detection rate. In conclusion, the SLNB in cervical cancer appears to be of diagnostic value, particularly the procedure with the combination of laparoscopy, combined tracers and immunohistochemistry. However, further studies are required to establish the clinical value of SLNB in cervical cancer.

The role of sentinel lymph nodes in endometrial and cervical cancer

“…Overall, using radiotracer with blue dye combinations has resulted in detection rates of 94% to 99.1%, significantly higher than either used alone . In a meta‐analysis, the pooled detection rate of dual tracers was 94.3% in cervical cancer . However, this study did not take into account injection method or stage of disease, which may drastically affect results.…”

“…Ultra‐staging has been associated with higher detection rates of micrometastasis and isolated tumor cells (ITCs) . A meta‐analysis of 17 trials with 1,112 cervical cancer patients reported a 93% detection rate with H&E and IHC compared to 89.4% with H&E alone . This translated into a 96% NPV and 90% sensitivity.…”

“…Retrospective studies have shown that the overall rate of involvement of pelvic lymph nodes, discovered via lymph node dissection, in early‐stage cases is 0–4.8% for stage IA, 17% for stage IB, and 12–27% in stage IIA disease . This suggests that >95% of stage IA cases may not need a full lymph node dissection while in stage IIA disease this number is lower.…”

Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…[75][76][77][78][79][80][81][82][83][84][85][86] Meta-analyses of pooled data from SLN mapping studies have generated SLN detection rates of 89% to 92% and sensitivity of 89% to 90%. 87,88 Factors determined to be important for detection included laparoscopy, dual blue dye/radiocolloid tracer approaches, and pathologic assessment using immunohistochemistry. However, based on a recent metaanalysis, indocyanine green tracer appears to provide similar overall and bilateral detection rates to the standard dual blue dye/technetium-99 approach.…”

The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer

“…Another promising method which might provide a more accurate identification of patients who present ovarian cancer lymph node metastases even in apparently early stages of the disease is represented by the sentinel node detection [4]. The method, which has been widely implemented in cases diagnosed with early stage breast cancer, melanoma and even gynecological cancers (such as endometrial cancer or cervical cancer), is still under evaluation in patients with presumed early stage ovarian cancer, further studies being still needed before introducing it as part of the standard therapeutic protocol [4,[15][16][17][18].…”