Sentinel-lymph-node procedures in early stage cervical cancer: a systematic review and meta-analysis

We performed a meta-analysis to assess the accuracy of sentinel-lymph-node (SLN) procedures for the assessment of nodal metastases in patients with early stage cervical cancer. Studies of SLN procedures for detecting nodal metastases in patients with early stage cervical cancer were systematically searched in MEDLINE and EMBASE between January 1, 2000 and August 30, 2013. We identified 49 eligible studies, which included 2,476 SLN procedures. The mean overall weighted-detection rate was 0.93 (95 % CI 0.92-0.94), at a pooled sensitivity of 0.88 (95 % CI 0.84-0.90) with limited heterogeneity (χ (2) = 80.57, degrees of freedom = 47, p = 0.002). Subgroup analysis of sensitivity and the rate of detection of different tracer techniques and surgery methods used in conjunction with an SLN procedures were as follows: studies using combined techniques, 0.88 (95 % CI 0.84-0.91) and 0.97 (95 % CI 0.96-0.98); studies using metastable technetium-99, 0.87 (95 % CI 0.78-0.93) and 0.90 (95 % CI 0.87-0.93); studies using blue dye, 0.87 (95 % CI 0.79-0.93) and 0.87 (95 % CI 0.84-0.90); studies using laparotomy, 0.86 (95 % CI 0.80-0.90) and 0.87 (95 % CI 0.83-0.91); studies using laparoscopy, 0.90 (95 % CI 0.86-0.94) and 0.93 (95 % CI 0.90-0.96); and studies using robot-assisted surgery, 0.84 (95 % CI 0.72-0.92) and 0.92 (95 % CI 0.88-0.95). We concluded that the SLN procedure performs well diagnostically for the assessment of nodal metastases in patients with early stage cervical cancer.