PurposeThe aim of this meta-analysis was to compare the reported sentinel lymph node detection rate (SDR), false-negative rate (FNR), and negative predictive value (NPV) as measures of performance of sentinel lymph node biopsy (SNB) techniques based on the use of radio-colloids, in clinically neck-negative T1/2 oro-oropharyngeal squamous cell carcinoma.MethodsStudies were stratified according to the SNB technique: (1) Tc-99m-nanocolloid planar lymphoscintigraphy with the use of intra-operative hand-held gamma-probe (L-G); (2) L-G with the additional contribution of pre-operative SPECT/CT (L-SPECT/CT-G); (3) L-G with the additional contribution of intra-operative blue dye or indocyanine green optical tracers (L-G-O); (4) L-SPECT/CT-G with the additional contribution of optical tracers (L-SPECT/CT-G-O). The SDRs were summarized accordingly. To summarize the FNRs and NPVs: (i) the index test (SNB) was based on histological evaluation of resected sentinel lymph nodes (SLN) performed on immunohistochemistry and step serial sectioning; (ii) the reference standards were the elective neck dissection or follow-up for tumor-free SNB.ResultsFrom a total of 3693 patients, the overall SDRs for the L-G, L-SPECT/CT-G, L-G-O, and L-SPECT/CT-G-O techniques were 98.2% (95% CI 97-99.1), 98.9% (95% CI 97.5-99.7), 97.4% (95% CI 95.3-98.9), and 98% (95% CI 95.8-99.2). From a total of 1634 patients, the overall FNRs for the L-G, L-SPECT/CT-G and L-G-O techniques were 8.5% (95% CI 3.4-15.5), 6.2% (95% CI 0.9-15.7), and 9.1% (95% CI 4.3-15.4); moreover, the overall NPVs were 93% (95% CI 90.5-94.9), 91.2% (95% CI 88.3-93.8), and 93.9% (95% CI 90.9-96.3), respectively. Promising initial findings emerged from L-SPECT/CT-G-O.ConclusionsThe superiority of SPECT/CT over planar methods has been reported for providing identification of SLNs by aberrant lymphatic drainage. The additional contribution of optical tracers (mainly represented by blue dye) to the radiocolloid-based techniques did not improve significantly the measures of performance.
Measures of performance for sentinel lymph node biopsy in oro-oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis
Garau, Ludovico M.;Nonne, Giovanna;Volterrani, Duccio;Manca, Gianpiero
2023-01-01
Abstract
PurposeThe aim of this meta-analysis was to compare the reported sentinel lymph node detection rate (SDR), false-negative rate (FNR), and negative predictive value (NPV) as measures of performance of sentinel lymph node biopsy (SNB) techniques based on the use of radio-colloids, in clinically neck-negative T1/2 oro-oropharyngeal squamous cell carcinoma.MethodsStudies were stratified according to the SNB technique: (1) Tc-99m-nanocolloid planar lymphoscintigraphy with the use of intra-operative hand-held gamma-probe (L-G); (2) L-G with the additional contribution of pre-operative SPECT/CT (L-SPECT/CT-G); (3) L-G with the additional contribution of intra-operative blue dye or indocyanine green optical tracers (L-G-O); (4) L-SPECT/CT-G with the additional contribution of optical tracers (L-SPECT/CT-G-O). The SDRs were summarized accordingly. To summarize the FNRs and NPVs: (i) the index test (SNB) was based on histological evaluation of resected sentinel lymph nodes (SLN) performed on immunohistochemistry and step serial sectioning; (ii) the reference standards were the elective neck dissection or follow-up for tumor-free SNB.ResultsFrom a total of 3693 patients, the overall SDRs for the L-G, L-SPECT/CT-G, L-G-O, and L-SPECT/CT-G-O techniques were 98.2% (95% CI 97-99.1), 98.9% (95% CI 97.5-99.7), 97.4% (95% CI 95.3-98.9), and 98% (95% CI 95.8-99.2). From a total of 1634 patients, the overall FNRs for the L-G, L-SPECT/CT-G and L-G-O techniques were 8.5% (95% CI 3.4-15.5), 6.2% (95% CI 0.9-15.7), and 9.1% (95% CI 4.3-15.4); moreover, the overall NPVs were 93% (95% CI 90.5-94.9), 91.2% (95% CI 88.3-93.8), and 93.9% (95% CI 90.9-96.3), respectively. Promising initial findings emerged from L-SPECT/CT-G-O.ConclusionsThe superiority of SPECT/CT over planar methods has been reported for providing identification of SLNs by aberrant lymphatic drainage. The additional contribution of optical tracers (mainly represented by blue dye) to the radiocolloid-based techniques did not improve significantly the measures of performance.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
