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Sentinel lymph node detection in early-stage ovarian cancer: a systematic review and meta-analysis
  1. Nuria Agusti1,2,
  2. David Viveros-Carreño3,4,
  3. Carlos Grillo-Ardila5,
  4. Nora Izquierdo1,
  5. Pilar Paredes6,7,8,
  6. Sergi Vidal-Sicart6,7,
  7. Aureli Torne1,7,8 and
  8. Berta Díaz-Feijoo1,7,8
  1. 1Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
  2. 2Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia, Bogota, Colombia
  4. 4Department of Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
  5. 5Department of Gynecology and Obstetrics, Universidad Nacional de Colombia - Sede Bogotá, Bogota, Colombia
  6. 6Department of Nuclear Medicine, Hospital Clinic de Barcelona, Barcelona, Spain
  7. 7IDIBAPS, Barcelona, Spain
  8. 8Faculty of Medicine, University of Barcelona, Barcelona, Spain
  1. Correspondence to Dr Nuria Agusti, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; NAgusti{at}mdanderson.org

Abstract

Background A systematic pelvic and para-aortic lymphadenectomy remains the surgical standard management of early-stage epithelial ovarian cancer. Sentinel lymph node mapping is being investigated as an alternative procedure; however, data reporting sentinel lymph node performance are heterogeneous and limited.

Objective A systematic pelvic and para-aortic lymphadenectomy remains the surgical standard management of early-stage epithelial ovarian cancer. Sentinel lymph node mapping is being investigated as an alternative procedure; however, data reporting on the sentinel lymph node performance are heterogeneous and limited. This study aimed to evaluate the detection rate and diagnostic accuracy of sentinel lymph node mapping in patients with early-stage ovarian cancer.

Methods A systematic search was conducted in Medline (through PubMed), Embase, Scopus, and the Cochrane Library. We included patients with clinical stage I–II ovarian cancer undergoing a sentinel lymph node biopsy and a pelvic and para-aortic lymphadenectomy as a reference standard. We conducted a meta-analysis for the detection rates and measures of diagnostic accuracy and assessed the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with identifying number CRD42022351497.

Results After duplicate removal, we identified 540 studies, 18 were assessed for eligibility, and nine studies including 113 patients were analyzed. The pooled detection rates were 93.3% per patient (95% CI 77.8% to 100%; I2=74.3%, p<0.0001), and the sentinel lymph node technique correctly identified 11 of 12 patients with lymph node metastases, with a negative predictive value per patient of 100% (95% CI 97.6% to 100%; I2=0%). The combination of indocyanine green and 99mTc-albumin nanocolloid had the best detection rate (100% (95% CI 94% to 100%; I2=0%)) when injected into the utero-ovarian and infundibulo-pelvic ligaments.

Conclusion Sentinel lymph node biopsy in early-stage ovarian cancer showed a high detection rate and negative predictive value. The utero-ovarian and infundibulo-pelvic injection using the indocyanine green and technetium-99 combination could increase sentinel lymph node detection rates. However, given the limited quality of evidence and the small number of reports, results from ongoing trials are awaited before its implementation in routine clinical practice.

  • Ovarian Cancer
  • Sentinel Lymph Node
  • Lymphatic Metastasis

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @nagustiga, @Bertadiazfeijoo#

  • Contributors NA is the principal investigator, designed the study, reviewed the literature, collected and analyzed data, and wrote the paper. DV-C contributed to conceptualizing the project, independently screening and assessing all studies, and edited the manuscript. CG contributed to conceptualizing the project and statistical assistance. NI contributed to independently screening and assessing all studies, and edited the manuscript. PP and SV-S contributed to conceptualizing the project and edited the manuscript. AT and BD-F contributed to conceptualizing the project, consulted for clinical expertise, reviewed the data and analyses, and edited the manuscript. NA is the guarantor and accepts full responsibility for the 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 None declared.

  • 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.

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