Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Ann Surg Oncol. 2012 May;19(5):1541-50. doi: 10.1245/s10434-011-2124-2. Epub 2011 Nov 3.
The possible application and validity of the sentinel lymph node (SLN) concept in gastric cancer (GC) is still debated. A systematic review to evaluate the diagnostic value of SLN biopsy (SLNB) in GC is urgently needed.
A systematic review of relevant literatures was performed in PubMed, Embase, and The Cochrane Library. A random-effect model was used to pool the data, and subgroup analysis was used to explain the heterogeneities.
A total of 38 included studies (2,128 patients) were included. The pooled SLN identification rate, sensitivity, negative predictive value, and accuracy were 93.7% (95% confidence interval [95% CI]: 91.1-95.6%), 76.9% (95% CI: 71.6-81.4%), 90.3% (95% CI: 86.9-92.9%), and 92.0% (95% CI: 89.9-93.7%), respectively. Subgroup analysis showed that early T stage, combined tracers, submucosal injection method, conventional open surgery, and usage of immunohistochemistry were associated with higher SLN identification rate and sensitivity.
SLNB in GC is technically feasible with an acceptable sensitivity. However, further studies are needed to confirm the best procedure and standard criteria.
前哨淋巴结（SLN）概念在胃癌（GC）中的应用和有效性仍存在争议。迫切需要进行系统评价来评估 SLN 活检（SLNB）在 GC 中的诊断价值。
在 PubMed、Embase 和 The Cochrane Library 中进行了相关文献的系统评价。使用随机效应模型对数据进行汇总，并进行亚组分析以解释异质性。
共纳入 38 项研究（2128 例患者）。SLN 识别率、敏感性、阴性预测值和准确性的汇总值分别为 93.7%（95%置信区间 [95%CI]：91.1-95.6%）、76.9%（95%CI：71.6-81.4%）、90.3%（95%CI：86.9-92.9%）和 92.0%（95%CI：89.9-93.7%）。亚组分析表明，早期 T 分期、联合示踪剂、黏膜下注射方法、传统开放手术和免疫组织化学的使用与更高的 SLN 识别率和敏感性相关。
GC 中的 SLNB 在技术上是可行的，具有可接受的敏感性。然而，需要进一步的研究来确认最佳程序和标准标准。
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