Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, China.
Department of Gastrointestinal Surgery, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China.
Updates Surg. 2021 Aug;73(4):1275-1284. doi: 10.1007/s13304-021-01026-2. Epub 2021 Mar 15.
Sentinel lymph node biopsy (SLNB) is intriguing because it is expected to further expand the indication of endoscopic resection (ER) for cT1N0M0 gastric cancer and as an additional operation for post-ER gastric cancer. The aim of our study was to perform a systematic review and meta-analysis on the feasibility and diagnostic value of SLNB technique in patients with cT1N0M0 gastric cancer. Eligible studies were systematically searched in PubMed, Embase, and Cochrane Library databases from inception to April 2020. A random-effect model was used to pool the data, and subgroup analysis was used to explain the heterogeneities. A total of 22 clinical studies (1993 patients with cT1N0M0 gastric cancer) were included. The pooled SLN identification rate, sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals were 0.99 (0.99-1.00), 0.92 (0.88-0.95), 1.00 (1.00-1.00), and 832.8 (395.5-1753.6), respectively. The summary receiver operator characteristic displayed a test accuracy of 99.3%. Subgroup analysis found an improved SLN sensitivity for studies with the mean number of SLNs > 4 and studies stained with a combination of hematoxylin-eosin with immunohistochemistry (HE + IHC). Further, studies using the basin dissection were associated with a higher SLN identification rate. The current meta-analysis provides data that favors the use of SLNB for predicting the status of lymph node metastasis in patients with cT1N0M0 gastric cancer. However, establishing standard procedure and suitable criteria for further application and optimization of SLNB is urgently needed.
前哨淋巴结活检（SLNB）很有吸引力，因为它有望进一步扩大内镜下切除（ER）治疗 cT1N0M0 胃癌的适应证，并作为 ER 后胃癌的附加手术。我们的研究目的是对 cT1N0M0 胃癌患者 SLNB 技术的可行性和诊断价值进行系统评价和荟萃分析。从开始到 2020 年 4 月，我们在 PubMed、Embase 和 Cochrane Library 数据库中系统地搜索了符合条件的研究。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 22 项临床研究（1993 例 cT1N0M0 胃癌患者）。SLN 识别率、敏感性、特异性和诊断比值比（95%置信区间）的合并值分别为 0.99（0.99-1.00）、0.92（0.88-0.95）、1.00（1.00-1.00）和 832.8（395.5-1753.6）。汇总受试者工作特征曲线显示测试准确性为 99.3%。亚组分析发现，对于 SLN 数量>4 的研究和使用苏木精-伊红联合免疫组化（HE+IHC）染色的研究，SLN 敏感性提高。此外，使用盆部解剖的研究与更高的 SLN 识别率相关。本荟萃分析提供的数据支持使用 SLNB 预测 cT1N0M0 胃癌患者淋巴结转移状态。然而，迫切需要建立标准程序和合适的标准，以进一步应用和优化 SLNB。
