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A Systematic Review and Meta-Analysis of Sentinel Lymph Node Biopsy in Gastric Cancer, an Optimization of Imaging Protocol for Tracer Mapping

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Abstract

Background

Sentinel lymph node biopsy (SLNB) plays an essential role in the evaluation of lymph node (LN) metastasis status and the extent of LN dissection in gastric cancer. The aim of our study was to perform a systematic review and meta-analysis for corresponding identification rate and sensitivity of different SLNB techniques.

Methods

Systematic search using PubMed, Embase, and Cochrane library databases was conducted for studies on SLNB in patients with gastric cancer. Studies were stratified according to the sentinel lymph node (SLN) biopsy technique: blue dye (BD), radiocolloid tracer (RI), indocyanine green (ICG), a combination of radiocolloid with blue dye (RI + BD), and a combination of radiocolloid with ICG (RI + ICG). A random-effect model was used to pool the identification rate, sensitivity, and accuracy.

Results

A total of 54 eligible studies (3767 patients) was included. The pooled identification rates of SLNB using BD, RI, ICG, RI + BD, RI + ICG were 95% (95%CI: 92–97%), 95% (95%CI: 93–97%), 99% (95%CI: 97–99%), 97% (95%CI: 96–98%), and 95% (95%CI: 87–99%), respectively. The pooled sensitivities were 82% (95%CI: 77–86%), 87% (95%CI: 81–92%), 90% (95%CI: 82–95%), 89% (95%CI: 84–93%), and 88% (95%CI: 79–94%), respectively. The pooled accuracies were 94% (95%CI: 91–96%), 95% (95%CI: 92–97%), 98% (95%CI: 95–99%), 97% (95%CI: 95–99%), and 98% (95%CI: 95–99%), respectively.

Conclusions

The current meta-analysis provides reliable evidence that favors the use of ICG and dual tracer method (RI + BD/ICG) for the identification of the SLN. Considering the high costs and potential biohazard of using radioactive substances in dual tracer method, performing SLNB with ICG is the technique of choice for experienced surgeons.

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Funding

This research was supported by the Natural Science Foundation of Fujian Province (Grant No. 2018J01377).

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  1. Yuqiang Huang and Mengting Pan contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China

    Yuqiang Huang & Bo Chen

  2. Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China

    Yuqiang Huang, Mengting Pan & Bo Chen

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  1. Yuqiang Huang
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Correspondence to Bo Chen.

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Huang, Y., Pan, M. & Chen, B. A Systematic Review and Meta-Analysis of Sentinel Lymph Node Biopsy in Gastric Cancer, an Optimization of Imaging Protocol for Tracer Mapping. World J Surg 45, 1126–1134 (2021). https://doi.org/10.1007/s00268-020-05900-9

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