Feasibility and diagnostic performance of dual-tracer-guided sentinel lymph node biopsy in cT1-2N0M0 gastric cancer: a systematic review and meta-analysis of diagnostic studies

Abstract

BackgroundDual-tracer-guided sentinel lymph node (SLN) biopsy may provide a promising diagnostic tool to assess accurately the status of lymph node metastasis in the surgical operation and assure the oncologic safety of the function or stomach preserving surgery. The diagnostic performance of this technology in recent studies varied. Thus, we conducted this meta-analysis.MethodsThis systematic review and meta-analysis was registered at the PROSPERO. Eligible studies were searched in the PubMed, EMBASE, Web of Knowledge, and Cochrane Library databases. A random-effect model was used to pool the data. Summary receiver operator characteristic curves, analysis for publication bias, meta-regression, and subgroup analysis were also performed.ResultsThe pooled SLN identification rate and sensitivity were 0.97 and 0.89. 99mTc-human serum albumin with indocyanine green (ICG), 99mTc-antimony sulfur colloid with ICG, performing SLN biopsy ≥15 min after dye injection, an SLN ≥5, the basin dissection, laparoscopic surgery, in studies conducted in Japan and studies published after 2012, were associated with higher sensitivity. CT1 stage, performing SLN biopsy ≥15 min after dye injection, in studies conducted in Japan and studies published after 2012, were related with a higher identification rate.ConclusionsDual tracer is promising in SLN biopsy in gastric cancer, and the clinical application of SLN biopsy should be limited to the patients of cT1N0M0 gastric cancer. The combination of 99mTc-human serum albumin and ICG as well as the combination of 99mTc-antimony sulfur colloid and ICG may be the optimal tracer combination. However, it seems not justified to put this technique into routine clinical application recently. Some factors that might enhance diagnostic value are identified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-017-1159-7) contains supplementary material, which is available to authorized users.

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

“…Therefore, we would like to focus on the mean number of SLN and to estimate its effect on the parameter of sensitivity. In the subgroup analysis, a result consistent with the previous meta‐analysis was obtained, that sensitivity was found to be significantly related to the harvested SLNs number . In addition, two IREE studies reported recalculated sensitivities by the number of lymph nodes with harvested mean SLN ≥ 5 (1.00 and 1.00, respectively) .…”

“…In the subgroup analysis, a result consistent with the previous meta-analysis was obtained, that sensitivity was found to be significantly related to the harvested SLNs number. 81,82 In addition, two IREE studies reported recalculated sensitivities by the number of lymph nodes with harvested mean SLN ≥ 5 (1.00 and 1.00, respectively). 51,55 These results indirectly reflect the complicated lymphatic system of the stomach that many directions of tracer flow lead to multiple SLNs, 34 An inverse correlation was commonly reported between cT stage and SLN staging, indicating that the diagnostic accuracy decreases from cT1 to cT3 tumors.…”

Laparoscopic Endoscopic Cooperative Surgery: Current Status and Perspective

“…Gastric Cancer -An Update gastric cancer. On the other hand, some researchers reported the utility of sentinel node biopsy in patients with gastric cancer [34][35][36]. Although gastric lymphatic drainage is often complicated, by using the dual tracer method with radiolabeled tin colloid and blue dye, Kitagawa reported that the sentinel node detection rate was 97.5% (387 of 397) and the accuracy of nodal evaluation for metastasis was 99% (383 of 387) in cT1 and tumors <4 cm [36].…”

Development and Validation a Nomogram for Predicting the Third Station Lymph Node Metastasis in Early Gastric Cancer

“…Sentinel lymph node (SLN) biopsy, an invasive method, was used for detection of metastatic LNs in GC [9]. Studies have shown that SLN biopsy was a promising tool to assess the LN metastases in T1-2 GC patients [10][11][12]. However, there are still debates regarding the effectiveness of LN detection techniques and oncological safety of biopsy.…”