Tax Casper, Rovers Maroeska M, de Graaf Corine, Zusterzeel Petra L M, Bekkers Ruud L M
Radboud University Medical Centre, Radboudumc Institute for Health Sciences, Department of Operating Rooms, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
Radboud University Medical Centre, Radboudumc Institute for Health Sciences, Department of Operating Rooms, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Centre, Radboudumc Institute for Health Sciences, Department of Health Evidence, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
Gynecol Oncol. 2015 Dec;139(3):559-67. doi: 10.1016/j.ygyno.2015.09.076. Epub 2015 Sep 28.
Recent reviews on the sentinel lymph node (SLN) procedure in cervical cancer have shown that bilateral SLN detection and ultra staging are safe and superior options compared to a unilateral detection, frozen section and H&E analysis. So far, nobody identified a subgroup of patients in whom a SLN procedure may replace pelvic lymph node dissection (PLND).
We searched PubMed, Embase, CINAHL and Cochrane from inception up to November 26, 2014. Studies reporting SLN detection, and/or histological outcome of the SLN were included. Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool by two independent reviewers. Data to complete 2×2 contingency tables were obtained, and patient-, study- and technique characteristics were extracted. Results were pooled and plotted in forest plots.
Forty-seven studies (4130 patients) were analyzed. Pooled data of diagnostic accuracy on ultra staging (18 studies; 1275 patients) showed a sensitivity of 94% (95% CI 80-99%) and negative predictive values ranging between 91 and 100%. After ultra staging, 19 false negative results remained. Prerequisites such as early FIGO stage (IA2, IB1, IIA primary tumor size <40mm), no suspicious pre-, and per-operative lymph nodes, and bilateral negative SLNs after ultra staging resulted in 1 remaining false negative result among 1257 patients (0.08%). Pooled data on a combined tracer in early stage cervical cancer patients with primary tumor size <20mm (6 studies; 276 patients) resulted in 87% bilateral SLN detection.
Early stage cervical cancer patients (FIGO IA2, IB1, IIA primary tumor size <40mm) who have no suspicious pre-, and per-operative lymph nodes, and have bilateral negative SLNs after ultra staging, have a residual risk of 0.08% (1/1257) on occult metastases. On the basis of these results we recommend not to perform a full PLND in these patients.
近期关于宫颈癌前哨淋巴结（SLN）手术的综述表明，与单侧检测、冰冻切片和苏木精-伊红（H&E）分析相比，双侧SLN检测和超分期是安全且更优的选择。到目前为止，尚未有人确定可采用SLN手术替代盆腔淋巴结清扫术（PLND）的患者亚组。
我们检索了自数据库建库至2014年11月26日的PubMed、Embase、CINAHL和Cochrane数据库。纳入报告SLN检测和/或SLN组织学结果的研究。由两名独立评审员使用诊断准确性研究质量评估工具评估方法学质量。获取完成2×2列联表的数据，并提取患者、研究和技术特征。汇总结果并绘制森林图。
分析了47项研究（4130例患者）。超分期诊断准确性的汇总数据（18项研究；1275例患者）显示敏感性为94%（95%可信区间80 - 99%），阴性预测值在91%至100%之间。超分期后仍有19例假阴性结果。国际妇产科联盟（FIGO）早期阶段（IA2、IB1、IIA期，原发肿瘤大小<40mm）、术前及术中无可疑淋巴结以及超分期后双侧SLN阴性等前提条件下，1257例患者中有1例假阴性结果（0.08%）。对原发肿瘤大小<20mm的早期宫颈癌患者联合使用示踪剂的汇总数据（6项研究；276例患者）显示双侧SLN检测率为87%。
早期宫颈癌患者（FIGO IA2、IB1、IIA期，原发肿瘤大小<40mm），术前及术中无可疑淋巴结，且超分期后双侧SLN阴性，隐匿性转移的残余风险为0.08%（1/1257）。基于这些结果，我们建议不对这些患者进行完整的PLND。
