Ji Qiang, Wang Xiuying, Jiang Jiyong, Chen Liyan
Gynecological Oncology Ward, Dalian Maternal and Child Health Hospital Affiliated to Dalian Medical University, Dalian, China.
Gland Surg. 2020 Dec;9(6):2091-2105. doi: 10.21037/gs-20-807.
In the staging of endometrial cancer (EC), the role of sentinel lymph node (SLN) mapping for high-risk EC is still unclear.
Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. English studies published in PubMed, Embase, and Cochrane Library before 20th SEP, 2019 were retrieved to perform a systematic evaluation and meta-analysis which evaluate the detection rate and diagnostic accuracy of SLN mapping in high-risk EC. Statistical analysis was conducted using stata14.0 software.
A total of 12 studies were included, including 758 high-risk EC patients. The detection rate of SLN mapping was 84.8% (95% CI, 79.9-89.6%). The pooled bilateral detection rate was 67.0% (95% CI, 56.8-77.3%). The pooled para-aortic detection rate was 8.4% (95% CI, 1.8-14.9%). The pooled sensitivity was 87% (95% CI, 79-92%), and the pooled specificity was 98% (95% CI, 96-99%). Pooled negative predictive value (NPV) was 97.7% (95% CI, 96.4-99.1%), AUC =0.99 (95% CI, 0.97-0.099).
SLN mapping still has a high detection rate and diagnostic accuracy in high-risk EC. SLN mapping is a reliable alternative to systematic lymph node dissection, but its prognostic effect on high-risk EC is yet to be further studied and verified by large sample studies.
在子宫内膜癌（EC）的分期中，前哨淋巴结（SLN）定位对于高危EC的作用仍不明确。
两位作者独立审查摘要和全文文章以确定纳入情况并评估研究质量。检索2019年9月20日前在PubMed、Embase和Cochrane图书馆发表的英文研究，以进行系统评价和荟萃分析，评估SLN定位在高危EC中的检出率和诊断准确性。使用stata14.0软件进行统计分析。
共纳入12项研究，包括758例高危EC患者。SLN定位的检出率为84.8%（95%CI，79.9 - 89.6%）。双侧检出率合并为67.0%（95%CI，56.8 - 77.3%）。腹主动脉旁检出率合并为8.4%（95%CI，1.8 - 14.9%）。合并敏感度为87%（95%CI，79 - 92%），合并特异度为98%（95%CI，96 - 99%）。合并阴性预测值（NPV）为97.7%（95%CI，96.4 - 99.1%），AUC = 0.99（95%CI，0.97 - 0.99）。
SLN定位在高危EC中仍具有较高的检出率和诊断准确性。SLN定位是系统性淋巴结清扫的可靠替代方法，但其对高危EC的预后影响尚待大样本研究进一步探讨和验证。
