Di Donna Mariano Catello, Quartuccio Natale, Giallombardo Vincenzo, Sturiale Letterio, Arnone Annachiara, Ricapito Rosaria, Sozzi Giulio, Arnone Gaspare, Chiantera Vito
Department of Gynecologic Oncology, University of Palermo, Piazza Nicola Leotta, 3, 90127, Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
Arch Gynecol Obstet. 2023 Jun;307(6):1677-1686. doi: 10.1007/s00404-022-06605-1. Epub 2022 May 24.
Sentinel lymph node (SLN) biopsy is widely accepted in the surgical staging of early vulvar cancer, although the most accurate method for its identification is not yet defined. This meta-analysis aimed to determine the technique with the highest pooled detection rate (DR) for the identification of SLN and compare the average number of SLNs detected by planar lymphoscintigraphy (PL), single-photon emission computed tomography/computed tomography (SPECT/CT), blue dye and indocyanine green (ICG) fluorescence.
The meta-analysis was conducted according to the PRISMA guideline. The search string was: "sentinel" and "vulv*", with date restriction from 1st January 2010 until Dec 31st, 2020. Three investigators selected studies based on: (1) a study cohort or a subset of a minimum of 10 patients with vulvar cancer undergoing either PL, SPECT/CT, blue-dye, or ICG fluorescence for the identification of SLN; (2) the possibility to extrapolate the DR or the average number of SLNs detected by a single technique (3) no evidence of other malignancies in the patient history.
A total of 30 studies were selected. In a per-patient and a per-groin analysis, the DR for SLN of PL was respectively 96.13% and 92.57%; for the blue dye was 90.44% and 66.21%; for the ICG, the DR was 91.90% and 94.80%. The pooled DR of SPECT/CT was not calculated, since only two studies were performed in this setting. At a patient-based analysis, no significant difference was documented among PL, blue dye, and ICG (p = 0.28). At a per-groin analysis, PL and ICG demonstrated a significantly higher DR compared to blue dye (p < 0.05). The average number of SLNs, on a per-patient analysis, was available only for PL and ICG with a median number of 2.61 and 1.78 lymph nodes detected, respectively, and no significant statistical difference.
This meta-analysis favors the use of ICG and PL alone and in combination over blue dye for the identification of the SLN in vulvar cancer. Future studies may investigate whether the combined approach allows the highest DR of SLN in patients with vulvar cancer.
前哨淋巴结（SLN）活检在早期外阴癌的手术分期中已被广泛接受，尽管其最准确的识别方法尚未确定。本荟萃分析旨在确定识别SLN时合并检出率（DR）最高的技术，并比较平面淋巴闪烁造影（PL）、单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）、蓝色染料和吲哚菁绿（ICG）荧光法所检测到的SLN的平均数量。
本荟萃分析按照PRISMA指南进行。检索词为：“前哨”和“外阴*”，日期限制为2010年1月1日至2020年12月31日。三名研究人员根据以下标准选择研究：（1）研究队列或至少10例接受PL、SPECT/CT、蓝色染料或ICG荧光法以识别SLN的外阴癌患者子集；（2）能够推断单一技术的DR或检测到的SLN的平均数量；（3）患者病史中无其他恶性肿瘤证据。
共选择了30项研究。在按患者和按腹股沟分析中，PL检测SLN的DR分别为96.13%和92.57%；蓝色染料为90.44%和66.21%；ICG的DR为91.90%和94.80%。未计算SPECT/CT的合并DR，因为在此设置下仅进行了两项研究。在基于患者的分析中，PL、蓝色染料和ICG之间未记录到显著差异（p = 0.28）。在按腹股沟分析中，PL和ICG的DR显著高于蓝色染料（p < 0.05）。在按患者分析中，仅PL和ICG有SLN的平均数量，分别检测到的淋巴结中位数为2.61和1.78，且无显著统计学差异。
本荟萃分析支持单独或联合使用ICG和PL而非蓝色染料来识别外阴癌中的SLN。未来的研究可调查联合方法是否能使外阴癌患者的SLN检出率最高。
