Predictive factors of sentinel lymph node mapping failure in cervical cancer: A systematic review and meta-analysis

Sentinel lymph node (SLN) mapping is crucial in cervical cancer, helping to assess lymph node status while reducing unnecessary systemic lymph node dissection. However, bilateral SLN mapping fails in 5 %-20 % of cases, with various contributing factors. This meta-analysis aims to identify predictive factors associated with SLN mapping failure in cervical cancer.

A comprehensive literature search was conducted across Cochrane, MEDLINE, Embase, PubMed, Web of Science, CBM, CNKI, WFDB, and VIP from inception to July 2024. Additional data were obtained from SRCTN, Physicians Data Query, ClinicalTrials, and the International Clinical Trials Registry Platform. Two independent researchers screened studies, assessed quality, and extracted data. The associations between predictive factors and SLN mapping failure were evaluated using odds ratios (ORs) with 95 % confidence intervals (CIs).

A total of 27 observational studies comprising 4059 patients were included. Significant predictive factors for SLN mapping failure included tumor size ≥2 cm [OR = 1.35, 95 % CI (1.05, 1.74), P = 0.018], age ≥50 years [OR = 2.71, 95 % CI (1.85, 3.97), P ≤ 0.001], FIGO stages II-IV [OR = 2.11, 95 % CI (1.20, 3.72), P = 0.009], pelvic lymph node metastasis [OR = 2.15, 95 % CI (1.10, 4.20), P = 0.025], and neoadjuvant chemotherapy (NACT) [OR = 1.44, 95 % CI (1.09, 1.90), P = 0.010]. Other factors including obesity, surgical approach, cervical conization, tumor differentiation, lymphovascular space invasion (LVSI), and histologic type were not associated with SLN mapping failure.

Larger tumor, older age, advanced FIGO stage, pelvic lymph node metastasis, and NACT are predictive factors for SLN mapping failure. These findings highlight the importance of preoperative assessment before SLN mapping.