Application of fluorescent tracers in ovarian cancer surgical navigation: a systematic review and meta-analysis

Ovarian cancer is a lethal gynecological health issue, that poses a serious threat to women's health worldwide. The objective of this study was to provide a literature overview of the application of fluorescent tracers during surgical ovarian cancer treatment.

We systematically searched 7 electronic databases from inception to September 2024. Studies were included if they investigated the application of fluorescence-guided surgery in patients with a diagnosis of ovarian cancer. Statistical analysis was performed with Stata 14.0 software, and the pooled detection rate and measures of diagnostic accuracy were evaluated. Subgroup analyses were carried out to evaluate the types of tracers, doses, injection sites, etc. Complications and adverse events were also reported. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for quality assessment.

A total of 21 studies with 681 participants were included. The overall sentinel lymph node (SLN) detection rate was 86.2% (95% CI: 69.6-97.5%; p = 0.000; I² = 82.540%) and ranged from 58.6 to 100% in individual studies. The sensitivity and specificity of SLN biopsy were 95.2% (95% CI: 71.0-100.0%; P = 0.022; I² = 73.893%) and 100.0% (95% CI: 99.9-100.0%; P = 0.810; I² = 0.000%), respectively. Four types of fluorescent materials, namely, indocyanine green (ICG), pafolacianine sodium (OLT38), 5-aminolevulinic acid (5-ALA), and folate conjugated to fluorescein isothiocyanate (EC17), were used to visualize tumor deposits and detect micrometastases. The greatest sensitivity value was noted with an EC17 of 98.2% (95% CI: 89.4-100.0%), whereas the greatest specificity and positive predictive value were noted with 5-ALA values of 96.9% (95% CI: 92.1-99.8%) and 96.9% (95% CI: 90.9-100.0%), respectively. Additionally, subgroup analysis revealed a greater SLN detection rate at an ICG dose of 0.625-1.25 mg than at an ICG dose of 0.5 mg or 2.5 mg. The incidence of adverse reactions ranged from 14.3% to 83.3%. Most events were mild or moderate in severity.

Fluorescence-guided surgery is a potentially safe and applicable technique in ovarian cancer surgery. However, considering the small number of participants and the heterogeneity, further studies are needed to better evaluate the accuracy outcomes regarding the type of tracer, dose, injection site, etc.