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

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Original research
Key issues in diagnostic accuracy of sentinel lymph node biopsy in early-stage ovarian cancer: systematic review and meta-analysis
  1. Iria Rey1,2,
  2. Víctor Lago1,2,3,
  3. Marta Arnáez1,2,
  4. Nicolò Bizzarri4,
  5. Nuria Agustí5,6,
  6. Camilla Nero4,
  7. Berta Díaz-Feijoo6,7,
  8. Pablo Padilla-Iserte1,3 and
  9. Santiago Domingo1,8
    1. 1 Department of Gynecologic Oncology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
    2. 2 Instituto de Investigacion Sanitaria La Fe, Valencia, Spain
    3. 3 Universidad Cardenal Herrera-CEU, Moncada, Spain
    4. 4 Department of Gynaecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
    5. 5 Department of Gynaecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    6. 6 Gynecologic Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic de Barcelona, Barcelona, Spain
    7. 7 Universidad de Barcelona, Barcelona, Spain
    8. 8 Universidad de Valencia, Valencia, Spain
    1. Correspondence to Dr Víctor Lago; victor.lago.leal{at}hotmail.com

    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

    • Ovarian Neoplasms
    • Sentinel Lymph Node
    • Lymphatic Metastasis

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    https://doi.org/10.1136/ijgc-2024-005970

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information.

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      Footnotes

      • X @Bertadiazfeijoo#

      • Contributors IR performed the literature search, independently screened and assessed all studies, collected and analyzed data, and wrote the manuscript. VL designed the study, independently screened and assessed all studies, reviewed the collected and analyzed data, and contributed equally to writing and editing the manuscript. IR is the guarantor of the study. MA, PP-I, and SD contributed to designing the project, and reviewing and editing the manuscript. NV, NA, CN, and BD-F reviewed the data and analyses, provided missing data, and edited the manuscript. JA provided statistical assistance. IR and VL accept full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests VL declares a research grant from AstraZeneca. CN declares travel support from MSD, Illumina, and AstraZeneca, and honoraria from Veeva, GSK, MSD, AstraZeneca, and Altems.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.