van de Lande Jonas, Torrenga Bas, Raijmakers Pieter G H M, Hoekstra Otto S, van Baal Marchien W, Brölmann Hans A M, Verheijen René H M
Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, P.O. Box 7057, The Netherlands.
Gynecol Oncol. 2007 Sep;106(3):604-13. doi: 10.1016/j.ygyno.2007.05.010. Epub 2007 Jul 12.
The aim of this study was to systematically review the diagnostic performance of Sentinel Node (SN) detection for assessing the nodal status in early stage cervical carcinoma, and to determine which technique (using blue dye, Technetium-99m colloid (99mTc), or the combined method) had the highest success rate in terms of detection rate and sensitivity.
A comprehensive computer literature search of English language studies in human subjects on Sentinel Node procedures was performed in MEDLINE and EMBASE databases up to July 2006. For each article two reviewers independently performed a methodological qualitative analysis and data extraction using a standard form. Pooled values of the SN detection rate and pooled sensitivity values of the SN procedure are presented with a 95% confidence interval (95% CI) for the three different SN detection techniques.
We identified 98 articles, and 23 met the inclusion criteria, comprising a total of 842 patients. Ultimately, 12 studies used the combined technique with a sensitivity of 92% (95% CI: 84-98%). Five studies used 99mTc-colloid, with a pooled sensitivity of 92% (95% CI: 79-98%; p=0.71 vs. combined technique), and four used blue dye with a pooled sensitivity of 81% (67-92%, p=0.17 vs. combined technique). The SN detection rate was highest for the combined technique: 97% (95% CI: 95-98%), vs. 84% for blue dye (95% CI: 79-89%; p<0.0001), and 88% (95% CI: 82-92%, p=0.0018) for 99mTc colloid.
SN biopsy has the highest SN detection rate when 99mTc is used in combination with blue dye (97%), and a sensitivity of 92%. Hence, according to the present evidence in literature the combination of 99mTc and a blue dye for SN biopsy in patients with early stage cervical cancer is a reliable method to detect lymph node metastases in early stage cervical cancer.
本研究旨在系统评价前哨淋巴结（SN）检测在评估早期宫颈癌淋巴结状态方面的诊断性能，并确定哪种技术（使用蓝色染料、锝-99m胶体（99mTc）或联合方法）在检测率和敏感性方面成功率最高。
截至2006年7月，在MEDLINE和EMBASE数据库中对有关人类受试者前哨淋巴结程序的英文研究进行了全面的计算机文献检索。对于每篇文章，两名评审员使用标准表格独立进行方法学定性分析和数据提取。给出了三种不同SN检测技术的SN检测率合并值和SN程序的合并敏感性值及其95%置信区间（95%CI）。
我们识别出98篇文章，23篇符合纳入标准，共包括842例患者。最终，12项研究使用联合技术，敏感性为92%（95%CI：84-98%）。5项研究使用99mTc胶体，合并敏感性为92%（95%CI：79-98%；与联合技术相比，p=0.71），4项研究使用蓝色染料，合并敏感性为81%（67-92%，与联合技术相比，p=0.17）。联合技术的SN检测率最高：97%（95%CI：95-98%），蓝色染料为84%（95%CI：79-89%；p<0.0001），99mTc胶体为88%（95%CI：82-92%，p=0.0018）。
当99mTc与蓝色染料联合使用时，SN活检的SN检测率最高（97%），敏感性为92%。因此，根据目前文献中的证据，对于早期宫颈癌患者，99mTc与蓝色染料联合用于SN活检是检测早期宫颈癌淋巴结转移的可靠方法。
