Key issues in diagnostic accuracy of sentinel lymph node biopsy in early-stage ovarian cancer: systematic review and meta-analysis.

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY International Journal of Gynecological Cancer Pub Date : 2024-11-04 DOI:10.1136/ijgc-2024-005970

Iria Rey, Víctor Lago, Marta Arnáez, Nicolò Bizzarri, Nuria Agustí, Camilla Nero, Berta Díaz-Feijoo, Pablo Padilla-Iserte, Santiago Domingo

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Abstract

Objective: Sentinel lymph node (SLN) mapping may reduce the morbidity of lymphadenectomy while maintaining diagnostic accuracy. Nevertheless, SLN mapping in epithelial ovarian cancer is still under investigation. This systematic review and meta-analysis aimed to assess the detection rate and diagnostic accuracy of SLN mapping for each field (pelvic and para-aortic), and to evaluate the tracers and doses used.

Methods: A systematic search was conducted in PubMed, Cochrane Library, Scopus, and Web of Science. Patients with clinical stages I-II ovarian cancer undergoing SLN biopsy (index test) and a systematic pelvic and para-aortic lymphadenectomy (reference standard) were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A meta-analysis was performed to assess SLN mapping detection rates and diagnostic accuracy for each field (pelvic and para-aortic) and by subgroups (type of tracer and dosage).

Results: 239 patients from four studies were included. The SLN detection rate was 59.5% (95% CI 50.2 to 68.1%) and 64.4% (95% CI 58.2 to 70.2%) for the pelvic and para-aortic fields, respectively. The use of technetium-99 (^99mTc), alone or in combination, compared with the use of indocyanine green alone, was associated with a higher detection rate in both the pelvic (66.6%; 95% CI 53.3 to 78.3%; p=0.1211) and para-aortic (87.1%; 95% CI 76.9 to 93.9%, p=0.0000013) fields. The use of 0.2-0.5 mL of indocyanine green was associated with higher pelvic (68%; 95% CI 53.3 to 80.4%, p=0.1057) and para-aortic (88.3%, 95% CI 77.4 to 95.2%, p=0.0000018) detection rates compared with a 2 mL indocyanine green injection. Diagnostic accuracy, sensitivity, specificity, and negative predictive value of SLN for lymph node metastasis were: 100% each for the pelvic field and 98.1%, 85.7%, 100%, and 97.8%, respectively, for the para-aortic field.

Conclusion: The use of ^99mTc in combination with a low volume injection (0.2-0.5 mL) of indocyanine green increased SLN detection rates. In apparent early stage epithelial ovarian cancer, SLN is a feasible technique with a high diagnostic accuracy.

Trial registration: PROSPERO CRD42024544812.

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早期卵巢癌前哨淋巴结活检诊断准确性的关键问题：系统综述和荟萃分析。

目的：前哨淋巴结（SLN）绘图可降低淋巴结切除术的发病率，同时保持诊断的准确性。然而，上皮性卵巢癌的前哨淋巴结造影仍在研究中。本系统综述和荟萃分析旨在评估 SLN 图谱在每个领域（盆腔和主动脉旁）的检出率和诊断准确性，并评估所用的示踪剂和剂量：方法：在 PubMed、Cochrane Library、Scopus 和 Web of Science 中进行了系统检索。研究纳入了接受SLN活检（指标检测）和系统性盆腔及主动脉旁淋巴结切除术（参考标准）的临床I-II期卵巢癌患者。采用诊断准确性研究质量评估2（QUADAS-2）工具评估偏倚风险。进行了一项荟萃分析，以评估每个领域（盆腔和主动脉旁）和亚组（示踪剂类型和剂量）的SLN图谱检测率和诊断准确性。骨盆和主动脉旁区域的 SLN 检测率分别为 59.5%（95% CI 50.2 至 68.1%）和 64.4%（95% CI 58.2 至 70.2%）。与单独使用吲哚菁绿相比，单独或联合使用锝-99（99mTc）在骨盆（66.6%；95% CI 53.3 至 78.3%；p=0.1211）和主动脉旁（87.1%；95% CI 76.9 至 93.9%，p=0.0000013）视野的检出率更高。与注射 2 毫升吲哚青绿相比，使用 0.2-0.5 毫升吲哚青绿的骨盆（68%；95% CI 53.3 至 80.4%，p=0.1057）和主动脉旁（88.3%；95% CI 77.4 至 95.2%，p=0.0000018）检出率更高。SLN 对淋巴结转移的诊断准确性、敏感性、特异性和阴性预测值分别为盆腔淋巴结转移的诊断准确性、敏感性、特异性和阴性预测值分别为 100%，主动脉旁淋巴结转移的诊断准确性、敏感性、特异性和阴性预测值分别为 98.1%、85.7%、100% 和 97.8%：结论：使用 99mTc 结合低容量注射（0.2-0.5 mL）吲哚菁绿可提高 SLN 检测率。在明显的早期上皮性卵巢癌中，SLN是一种诊断准确率较高的可行技术：试验注册：PREMCO CRD42024544812。

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来源期刊

International Journal of Gynecological Cancer 医学-妇产科学

CiteScore

6.60

自引率

10.40%

发文量

280

审稿时长

3-6 weeks

期刊介绍： The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.