Sentinel lymph node detection and accuracy in vulvar cancer: Meta-analysis and systemic review

Abstract

Background Based on previous publication including RCTs and meta-analysis, sentinel lymph node (SLN) biopsy in women with early vulvar cancer is considered as a safe and effective procedure which is alternative to inguinofemoral lymph node dissection. However, near infrared imaging with indocyanine green (ICG) injection has emerged recently. Moreover, meta-analysis has not been updated for six years. We conducted a meta-analysis to evaluate the accuracy of SLN biopsy in vulval cancer.

Methods Relevant studies were identified using the PubMed, MEDLINE, and Cochrane databases. The outcomes of this study were detection rate, false negative rate and clinical accuracy of SLN biopsy with radiocolloid tracer, blue dye or ICG.

Results Of the 887 references, 51 studies were included. Pooled per groin detection rate for SLN biopsy using radiocolloid tracer, ICG and blue dye were 0.96 (0.93-0.98), 0.90 (0.83-0.98) and 0.72 (0.62-0.81), respectively. In meta-regression, SLN biopsy using radiocolloid tracer or ICG or both is significant moderator for detection of SLN (p=0.013).

Conclusions SLN biopsy using radiocolloid tracer, ICG is highly reliable and accurate in selected patients under strict protocol. The utilization of ICG for SLN sampling is feasible and promising in future.