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Performance of Indocyanine green for sentinel lymph node mapping and lymph node metastasis in colorectal cancer: a diagnostic test accuracy meta-analysis

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Abstract

Background

Indocyanine green has been widely employed as a secure and easy technique for sentinel lymph node mapping in different types of cancer. Nonetheless, the usage of Indocyanine green has not been fully implemented due to the heterogeneous results found in published studies. Thus, the objective of this meta-analysis is to evaluate the overall performance of Indocyanine green for sentinel lymph node mapping and node metastasis in patients undergoing colorectal cancer surgery.

Methods

An extensive systematic search was performed to identify relevant studies in English and Spanish with no time limit restrictions. For the meta-analysis, a hierarchical summary receiver operating characteristic curve (HSROCs) was constructed, and quantitative data synthesis was performed using random effects models. Specificity, sensitivity, positive, and negative likelihood ratios were obtained from the corresponding HSROC. Between-study heterogeneity was visually evaluated using Galbraith plot, and publication bias was quantified using Deeks’ method.

Results

A total of 11 studies were included for analysis. The pooled detection rate for sentinel lymph node mapping was 91% (80–98%). Covariates significantly influencing the pooled detection rate were having colon cancer (estimate: 1.3001; 1.114 to 1.486; p < 0.001) and the usage of a laparoscopic approach (estimate: 1.3495; 1.1029 to 1.5961; p < 0.001). The performance of Indocyanine green for the detection of metastatic lymph nodes yielded an area under the roc curve of 66.5%, sensitivity of 64.3% (51–76%), and specificity of 65% (36–85%).

Conclusions

Indocyanine green for the detection of sentinel lymph node mapping demonstrates better accuracy when used in colonic cancer and by a laparoscopic approach. Nevertheless, its overall performance for the detection of lymph node metastasis is poor.

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Acknowledgements

We are grateful to Dr. Jose Rafael Villafan-Bernal for his help in carefully revising the manuscript.

Funding

No funding was needed for this study.

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Authors and Affiliations

  1. Hospital Clínic de Barcelona, Universitat de Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain

    E. Villegas-Tovar, J. Jimenez-Lillo, V. Jimenez-Valerio, A. Otero-Piñeiro, F. B. De Lacy, R. J. Martinez-Portilla & A. M. Lacy

  2. Hospital Médica Sur, Mexico City, Mexico

    A. Diaz-Giron-Gidi

  3. Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Mérida, Yucatán, Mexico

    R. Faes-Petersen

  4. Maternal-Fetal Medicine and Therapy Research Center Mexico, in behalf of the Iberoamerican Research Network in Translational, Molecular and Maternal-Fetal Medicine, Mexico City, Mexico

    R. J. Martinez-Portilla

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  1. E. Villegas-Tovar
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Contributions

All authors participated in the study. VTE, JLJ, and JVV performed the literature search and the acquisition of data. DGG and FPR performed the quality analysis for the selected studies. MPR and DLFB performed the data analysis. MPB, OPA, and LAM participated in the interpretation of data and revised the article. All authors approved the final version of the article.

Corresponding author

Correspondence to R. J. Martinez-Portilla.

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Conflict of interest

Antonio M. Lacy, PhD. reports grants from Medtronic, grants from Olympus Medical, personal fees from Applied Medical, personal fees from Conmed, outside the submitted work, but reports no conflicts of interests. Eduardo Villegas-Tovar, Julio Jimenez-Lillo, Valeria Jimenez-Valerio, Alejandro Diaz-Giron-Gidi, Regina Faes-Petersen, Ana Otero-Piñeiro, Beatriz Martin-Perez, Borja De Lacy, and Raigam J. Martinez-Portilla have no conflicts of interest or financial ties to disclose.

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Villegas-Tovar, E., Jimenez-Lillo, J., Jimenez-Valerio, V. et al. Performance of Indocyanine green for sentinel lymph node mapping and lymph node metastasis in colorectal cancer: a diagnostic test accuracy meta-analysis. Surg Endosc 34, 1035–1047 (2020). https://doi.org/10.1007/s00464-019-07274-z

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