Zarifmahmoudi Leili, Ghorbani Hamidreza, Sadri Kayvan, Tavakkoli Mahmoud, Keshvari Maliheh, Salehi Maryam, Sadeghi Ramin
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Urol Int. 2019;103(4):373-382. doi: 10.1159/000497310. Epub 2019 Mar 5.
To determine the application of sentinel node biopsy in urothelial carcinoma of the bladder, we performed a systematic review and meta-analysis.
Pooled false negative rate and detection rate were presented using Meta-Disc (version 1.4), and comprehensive meta-analysis (version 2). Publication bias and heterogeneity were assessed using funnel plot, Cochrane Q test, and I2 index.
The pooled detection rate was 91% (95% CI 87-93%) and pooled sensitivity was 79% (95% CI 0.69-0.86%). When the neoadjuvant chemotherapy group of patients was omitted, the pooled sensitivity changed to 82% (95% CI 74-88%), and the Cochrane Q and I2 statistics were 15.44 and 48.2%, respectively. The pooled sensitivity of studies that included > 50% of pT 3 or 4 patients was 70% (59-80), by omitting studies that enrolled > 50% of patients at pT stage of 3 or 4, the pooled sensitivity increased to 93% (81-98).
Although the studies on SN biopsy of muscle invasive bladder cancer patients resulted in a high detection rate and sensitivity, further validated multicenter trials with larger sample size are essential to confirm the reliability and accuracy of this approach and obtain a standardized method. We showed that pT1 or pT2 bladder cancer patients with clinically negative lymph nodes are the most appropriated group for sentinel lymph node mapping.
为了确定前哨淋巴结活检在膀胱尿路上皮癌中的应用，我们进行了一项系统评价和荟萃分析。
使用Meta-Disc（1.4版）和综合荟萃分析（2版）呈现合并假阴性率和检出率。使用漏斗图、Cochrane Q检验和I²指数评估发表偏倚和异质性。
合并检出率为91%（95%CI 87 - 93%），合并敏感性为79%（95%CI 0.69 - 0.86%）。当剔除新辅助化疗组患者时，合并敏感性变为82%（95%CI 74 - 88%），Cochrane Q和I²统计量分别为15.44和48.2%。纳入超过50% pT3或4期患者的研究的合并敏感性为70%（59 - 80），通过剔除纳入超过50% pT3或4期患者的研究，合并敏感性增至93%（81 - 98）。
尽管关于肌肉浸润性膀胱癌患者前哨淋巴结活检的研究有较高的检出率和敏感性，但进一步进行更大样本量的多中心验证试验对于确认该方法的可靠性和准确性并获得标准化方法至关重要。我们表明，临床淋巴结阴性的pT1或pT2期膀胱癌患者是前哨淋巴结定位最适合的人群。
