Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis

Chen, Yongfeng; Xiao, Qi; Zou, Weina; Xia, Chengwan; Yin, Hongling; Pu, Yaoyu; Wang, Yuxin; Zhang, Kai

doi:10.6061/clinics/2021/e2573

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…Since the beginning of the 21 st century, personalized minimally invasive surgery to preserve the function of the stomach has not only been proposed as a new surgical strategy for gastric cancer but also as an urgent requirement for accurate preoperative staging of gastric cancer[ 21 ]. Following the traditional SLN biopsy technique for gastric cancer, optical imaging combined with ICG-guided SLN biopsy of gastric cancer has gradually been included in clinical studies, so it is necessary to objectively evaluate its diagnostic accuracy[ 22 - 24 ].…”

Section: Discussionmentioning

confidence: 99%

Application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy diagnosis of gastric cancer: Meta-analysis

Zhang,

Cao,

Zhu

et al. 2024

World J Gastrointest Surg

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BACKGROUND Gastric cancer is a common malignant tumor of the digestive system worldwide, and its early diagnosis is crucial to improve the survival rate of patients. Indocyanine green fluorescence imaging (ICG-FI), as a new imaging technology, has shown potential application prospects in oncology surgery. The meta-analysis to study the application value of ICG-FI in the diagnosis of gastric cancer sentinel lymph node biopsy is helpful to comprehensively evaluate the clinical effect of this technology and provide more reliable guidance for clinical practice. AIM To assess the diagnostic efficacy of optical imaging in conjunction with indocyanine green (ICG)-guided sentinel lymph node (SLN) biopsy for gastric cancer. METHODS Electronic databases such as PubMed, Embase, Medline, Web of Science, and the Cochrane Library were searched for prospective diagnostic tests of optical imaging combined with ICG-guided SLN biopsy. Stata 12.0 software was used for analysis by combining the "bivariable mixed effect model" with the "midas" command. The true positive value, false positive value, false negative value, true negative value, and other information from the included literature were extracted. A literature quality assessment map was drawn to describe the overall quality of the included literature. A forest plot was used for heterogeneity analysis, and P < 0.01 was considered to indicate statistical significance. A funnel plot was used to assess publication bias, and P < 0.1 was considered to indicate statistical significance. The summary receiver operating characteristic (SROC) curve was used to calculate the area under the curve (AUC) to determine the diagnostic accuracy. If there was interstudy heterogeneity (I 2 > 50%), meta-regression analysis and subgroup analysis were performed. RESULTS Optical imaging involves two methods: Near-infrared (NIR) imaging and fluorescence imaging. A combination of optical imaging and ICG-guided SLN biopsy was useful for diagnosis. The positive likelihood ratio was 30.39 (95%CI: 0.92-1.00), the sensitivity was 0.95 (95%CI: 0.82-0.99), and the specificity was 1.00 (95%CI: 0.92-1.00). The negative likelihood ratio was 0.05 (95%CI: 0.01-0.20), the diagnostic odds ratio was 225.54 (95%CI: 88.81-572.77), and the SROC AUC was 1.00 (95%CI: The crucial values were sensitivity = 0.95 (95%CI: 0.82-0.99) and specificity = 1.00 (95%CI: 0.92-1.00). The Deeks method revealed that the "diagnostic odds ratio" funnel plot of SLN biopsy for gastric cancer was significantly asymmetrical (P = 0.01), suggesting significant publication bias. Further meta-subgroup analysis revealed that, compared with fluorescence imaging, NIR imaging had greater sensitivity (0.98 vs 0.73). Compared with optical imaging immediately after ICG injection, optical imaging after 20 minutes obtained greater sensitivity (0.98 vs 0.70). Compared with that of patients with an average SLN detection number < 4, the sensitivity of patients with a SLN detection number ≥ 4 was greater (0.96 vs 0.68). Compared with hematoxylin-eosin (HE) staining, immunohistochemical (+ HE) staining showed greater sensitivity (0.99 vs 0.84). Compared with subserous injection of ICG, submucosal injection achieved greater sensitivity (0.98 vs 0.40). Compared with 5 g/L ICG, 0.5 and 0.05 g/L ICG had greater sensitivity (0.98 vs 0.83), and cT1 stage had greater sensitivity (0.96 vs 0.72) than cT2 to cT3 clinical stage. Compared with that of patients ≤ 26, the sensitivity of patients > 26 was greater (0.96 vs 0.65). Compared with the literature published before 2010, the sensitivity of the literature published after 2010 was greater (0.97 vs 0.81), and the differences were statistically significant (all P < 0.05). CONCLUSION For the diagnosis of stomach cancer, optical imaging in conjunction with ICG-guided SLN biopsy is a therapeutically viable approach, especially for early gastric cancer. The concentration of ICG used in the SLN biopsy of gastric cancer may be too high. Moreover, NIR imaging is better than fluorescence imaging and may obtain higher sensitivity.

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Section: Discussionmentioning

confidence: 99%

Application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy diagnosis of gastric cancer: Meta-analysis

Zhang,

Cao,

Zhu

et al. 2024

World J Gastrointest Surg

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Indocyanine green fluorescence‐guided sentinel lymph node biopsy: A systematic review

Venkatesh,

De Ravin,

Rajasekaran

2024

World j. otorhinolaryngol.-head neck surg.

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ObjectivesAccurate staging of cervical lymph nodes is crucial in the management of head and neck cancers (HNCs). Sentinel lymph node biopsy (SLNB) offers a minimally invasive alternative to neck dissection for identifying occult metastases. This review aims to assess the feasibility and effectiveness of indocyanine green (ICG) fluorescence‐guided SLNB for HNCs.MethodsSystematic searches of the PubMed, Embase, and Scopus databases were conducted to identify all clinical articles on ICG‐guided SLNB in HNC from database inception through May 1, 2022. Numerous variables were extracted across papers, including patient and study characteristics, imaging parameters, and SLN detection rates. Risk of bias was evaluated via the Methodological Index for Non‐Randomized Studies (MINORS) criteria.ResultsA final six studies met inclusion criteria, encompassing 86 distinct head and neck tumors. The mean number of SLNs identified was 2.46 for fluorescence imaging and 2.83 for gamma tracing. Fluorescence imaging exhibited a higher pooled SLN detection rate (98.0%) compared to gamma tracing (87.6%). Pooled sensitivity for fluorescence imaging (71.0%) was also determined to be higher than that for gamma tracing (66.7%). Pooled specificity was 100% across both modalities. Studies were assessed to be of moderate quality by the MINORS criteria, with an average score of 11.25 for noncomparative studies and 20.5 for comparative studies.ConclusionsICG‐guided SLNB procedures are feasible and effective in the context of HNCs. The technique offers potentially higher SLN detection rates and shows promise in enhancing clinical and oncologic outcomes when compared to standard lymphoscintigraphy. Further studies with standardized metrics are, however, needed to validate these findings and identify optimal imaging techniques and parameters.

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Application of indocyanine green in the management of oral cancer: a literature review

Zhou,

Nan

2023

Oncologie

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Indocyanine green is a cyanine dye that displays fluorescent properties in the near-infrared region. Indocyanine green has good water solubility and can bind to plasma proteins in the body. After binding, it can display green fluorescence when irradiated by near-infrared fluorescence. Owing to its good imaging ability and low side effects, indocyanine green is widely used in the diagnosis and treatment of various tumors. Indocyanine green-assisted sentinel lymph node biopsy helps determine clean tumor boundaries, helps surgeons remove primary tumors completely, assists in microvascular anastomosis in head and neck repair and reconstruction, reduces operation time, evaluates blood perfusion to monitor flap status. In addition, indocyanine green has great potential in photodynamic therapy to specifically kill tumor cells. However, despite the benefits, studies regarding the application of indocyanine green in oral cancer are limited. Therefore, we conducted a literature review to explore the application of indocyanine green in oral cancer to benefit clinicians involved in the diagnosis and treatment of this disease.

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Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis

Cited by 3 publications

References 30 publications

Application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy diagnosis of gastric cancer: Meta-analysis

Application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy diagnosis of gastric cancer: Meta-analysis

Indocyanine green fluorescence‐guided sentinel lymph node biopsy: A systematic review

Application of indocyanine green in the management of oral cancer: a literature review

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