Feng Chuanli, Jiang Xuji, Feng Lianlian, Sun Wanying, Liu Qingqing, Hao Yiping, Cui Baoxia
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Shandong Province, People's Republic of China.
Int J Surg. 2025 Jan 1;111(1):1397-1406. doi: 10.1097/JS9.0000000000002064.
In the realm of endometrial cancer (EC) therapeutics and prognostic assessments, lymph nodes' status is paramount. The sentinel lymph node (SLN) detection, recognized for its reliability, has been progressively adopted as a standard procedure, posing a compelling alternative to conventional systematic lymphadenectomy. However, there remains a lack of agreement on the most effective choice of tracers for this procedure.
This investigation was dedicated to a comparative analysis of various tracers to identify the most effective combination that achieves the highest detection rate. This endeavor sought to enhance the efficacy of SLN biopsy in the surgical management of EC.
A systematic review was conducted across multiple databases, including the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Embase, and clinicaltrials.gov, to analyze studies employing different tracers for SLN biopsy during surgery in EC. Using Bayesian network meta-analysis, the authors compared the total and bilateral detection rates of various tracers.
After screening 1431 articles, 11 studies, including 2699 participants, were selected in this network meta-analysis. The combination of radioactive isotopes and indocyanine green (ICG) emerged as the most efficacious method in total and bilateral detection rates, with the Surface Under the Cumulative Ranking Curve (SUCRA) scores of 80.00 and 86.36%, respectively. Additionally, carbon nanoparticles (CNPs) demonstrated superior performance in the detection of para-aortic lymph nodes with an SUCRA score of 97.77%.
Network meta-analysis shows that the application of radioactive isotopes and ICG is the optimal tracer combination for SLN biopsy during surgery in EC.
在子宫内膜癌（EC）的治疗和预后评估领域，淋巴结状态至关重要。前哨淋巴结（SLN）检测因其可靠性而得到认可，并已逐渐被采用为标准程序，成为传统系统性淋巴结清扫术的有力替代方案。然而，对于该程序中最有效的示踪剂选择仍存在分歧。
本研究致力于对各种示踪剂进行比较分析，以确定能实现最高检出率的最有效组合。这一努力旨在提高EC手术管理中SLN活检的疗效。
在多个数据库中进行了系统评价，包括Cochrane对照试验中央注册库、PubMed、科学网、Embase和clinicaltrials.gov，以分析在EC手术中采用不同示踪剂进行SLN活检的研究。作者使用贝叶斯网络荟萃分析比较了各种示踪剂的总检出率和双侧检出率。
在筛选了1431篇文章后，本网络荟萃分析纳入了11项研究，共2699名参与者。放射性同位素与吲哚菁绿（ICG）的组合在总检出率和双侧检出率方面均为最有效方法，累积排序曲线下面积（SUCRA）分数分别为80.00%和86.36%。此外，碳纳米颗粒（CNPs）在腹主动脉旁淋巴结检测中表现出色，SUCRA分数为97.77%。
网络荟萃分析表明，放射性同位素与ICG的联合应用是EC手术中SLN活检的最佳示踪剂组合。
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