Elsevier

Lung Cancer

Volume 80, Issue 1, April 2013, Pages 5-14
Lung Cancer

Review
Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: Systematic review and meta-analysis of the literature

https://doi.org/10.1016/j.lungcan.2013.01.001Get rights and content

Abstract

Background

Not all patients with non-small cell lung carcinoma (NSCLC) have mediastinal lymph node involvement and development of less invasive methods for evaluating mediastinal lymph nodes is important. Sentinel node biopsy has been used for NSCLC since 1999 to decrease the need for mediastinal lymph node dissection. In this review, we searched the literature in this regard and reported the results in a meta-analysis format.

Methods

Medline, SCOPUS, and ISI web of knowledge were searched using: “(lung AND sentinel)” with no date or language limit. Any study with more than 5 patients and enough information to calculate detection rate and sensitivity was included.

Results

Overall 47 and 43 studies (including subgroups) had the criteria for detection rate and sensitivity pooling respectively. Pooled detection rate was 80.6% [76.8–84%] and pooled sensitivity was 87% [83–90%]. Using radiotracers or both radiotracers and dyes had higher detection rate and sensitivity compared to dye alone. Among studies using radiotracers, highest detection rate was in intra-operative peri-tumoral injection group and highest sensitivity was in peri-tumoral pre-operative injection group. Emerging methods of sentinel node surgery including magnetic materials, fluorescent dyes, CT contrast agents, and carbon nano-particles had promising results.

Conclusions

Sentinel node mapping using radiotracers is a feasible technique for mediastinal lymph node staging of N0 NSCLC patients. Alternative methods of sentinel node mapping are promising and warrant further studies.

Introduction

Despite recent advances in systemic therapy and radiotherapy, surgery remains and integral component of curative treatment of non-small cell lung cancer (NSCLC) [1]. Mediastinal lymph node dissection is an important part of NSCLC surgery which is associated with improved staging and survival [2]. However, mediastinal lymph node dissection may not be therapeutic for the majority of patients with NSCLC, since less than 30% of clinically stage I patients have mediastinal lymph node involvement [3]. Due to this fact and significant morbidity of mediastinal lymph node dissection [4], development of less invasive methods for evaluating mediastinal lymph nodes is important.

Sentinel node (SN) biopsy is an important technique for regional lymph node staging of many solid tumors [5]. This method allows determination of pathological node status by removing a limited number of lymph nodes and this in decreased morbidity. This procedure was applied to patients with NSCLC beginning in 1999 [6] and since then there has been an expanding body of literature.

In the current study, we systematically searched the literature on SN biopsy in NSCLC and report the results in a systematic review and meta-analysis format.

Section snippets

Materials and methods

This study was approved by Institutional Review Board of Mashhad University of Medical Sciences under the approval number of 910245.

Medline, SCOPUS, and ISI web of knowledge were searched with the following search terms: (lung AND sentinel) with no date or language limit. The last search was done on 11 January 2012. Meeting abstracts were also included if meeting below-mentioned criteria. The reference lists of the retrieved studies as well as citing articles were searched for any other

Results

Fig. 1 shows the summary of literature search outcomes. Overall, 41published reports were included in the systematic review [3], [6], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50]. Four reports had 2 patient groups and one report had 3 patient groups for a total of 47 patient groups [22], [29], [30], [38], [46]

Discussion

According to this meta-analysis, the pooled rate for detecting SNs was 80.6% [76.7–84%]. Sub-group analysis showed that inclusion of a radiotracer had better sensitivity than dye alone. The rate of detecting SNs, especially when including a radiotracer, was comparable to detection rates in other cancer types such as breast cancer [51], [52]. Lower detection rate by dye alone may be related to preexisting black discoloration of the mediastinal lymph nodes in most patients which can make it

Conclusions

SN mapping is a feasible for mediastinal lymph node staging of N0 NSCLC patients. Using a mapping method that includes a radiotracer results in detection rates and sensitivity comparable to outcomes in other tumor types. Peri-tumoral and pre-operative (CT guided or through bronchoscopy) injection of the tracer seem to be more successful compared to intra-tumoral and intra-operative injections.

Novel methods of SN mapping such as magnetic materials, fluorescent dyes, CT contrast agents, and

Conflict of interest statement

The authors declare no conflict of interest.

Acknowledgements

The study was supported financially by Vice Chancellery of Research of Mashhad University of Medical Sciences under the approval number of 910245. The sponsor of this study only supported the study financially and did not have any role in any other part of study performance.

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