ReviewAccuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: Systematic review and meta-analysis of the literature
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.
References (58)
- et al.
In vivo identification of sentinel lymph nodes for clinical stage I non-small cell lung cancer for abbreviation of mediastinal lymph node dissection
Lung Cancer
(2004) - et al.
Intraoperative lymphatic mapping for non-small cell lung cancer: the sentinel node technique
J Thorac Cardiovasc Surg
(1999) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Feasibility of the detection of the sentinel lymph node in peripheral non-small cell lung cancer with radio isotopic and blue dye techniques
Chest
(2005) - et al.
Intraoperative sentinel node mapping with technitium-99 in lung cancer: results of CALGB 140203 multicenter phase II trial
J Thorac Oncol
(2009) - et al.
A novel method for sentinel lymph node mapping using magnetite in patients with non-small cell lung cancer
J Thorac Cardiovasc Surg
(2003) - et al.
Intraoperative sentinel lymph node mapping using a new sterilizable magnetometer in patients with nonsmall cell lung cancer
Ann Thorac Surg
(2006) - et al.
Difference of sentinel lymph node identification between tin colloid and phytate in patients with non-small cell lung cancer
Ann Thorac Surg
(2009) - et al.
Computed tomography lymphography by transbronchial injection of iopamidol to identify sentinel nodes in preoperative patients with non-small cell lung cancer: a pilot study
J Thorac Cardiovasc Surg
(2012) - et al.
Preoperative imaging of the lung sentinel lymphatic basin with computed tomographic lymphography: a preliminary study
Ann Thorac Surg
(2004)
Comparison of three tracers for detecting sentinel lymph nodes in patients with clinical N0 lung cancer
Lung Cancer
Intraoperative, radio-guided sentinel lymph node mapping in 110 nonsmall cell lung cancer patients
Ann Thorac Surg
The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: systematic review and meta-analysis of the literature
Eur J Surg Oncol
Mode of spread in the early phase of lymphatic metastasis in non-small-cell lung cancer: significance of nodal micrometastasis
J Thorac Cardiovasc Surg
Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer
Rev Esp Med Nucl
In patients undergoing lung resection for non-small cell lung cancer, is lymph node dissection or sampling superior?
Interact Cardiovasc Thorac Surg
Complete mediastinal lymphadenectomy: the core component of the multidisciplinary therapy in resectable non-small cell lung cancer
Eur J Cardiothorac Surg
Video-assisted mediastinal lymph node dissection assessed in an experimental setting
Surg Endosc
Impact of nodal status and tumor burden in sentinel lymph nodes on the clinical outcomes of cancer patients
J Surg Oncol
Bias in meta-analysis detected by a simple, graphical test
BMJ
Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis
Biometrics
Meta-DiSc: a software for meta-analysis of test accuracy data
BMC Med Res Methodol
Intraoperative detection of sentinel lymph nodes using Patent Blue V in non-small cell lung cancer
Minerva Chir
Sentinel node detection and its importance in the surgical treatment of non-small cell lung carcinoma – review
Rozhl Chir
Lymphatic mapping and sentinel lymphadenectomy for primary and metastatic pulmonary malignant neoplasms
Arch Surg
Non-small cell lung cancer sentinel lymph node biopsy in clinical research
Contemp Chin Med
Intraoperative sentinel lymph node mapping for non-small cell lung cancer
Chin J Prim Med Pharm
Intraoperative detection of sentinel lymph nodes using carbon nanoparticles suspension injection in non-small cell lung cancer
Chin J Surg Oncol
Cited by (33)
Differential Diagnosis of Mediastinal Masses
2021, Encyclopedia of Respiratory Medicine, Second EditionBiopsy of the sentinel node in lung cancer
2017, Medicina ClinicaAdded value of blue dye injection in sentinel node biopsy of breast cancer patients: Do all patients need blue dye?
2014, International Journal of SurgeryCitation Excerpt :The rationale behind using two agents (radiotracer and blue dye) for sentinel node mapping is to increase detection rate of sentinel nodes and more importantly to decrease the false negative rate of the procedure [5,16–19]. This approach is also valid for sentinel node biopsy of other tumors besides breast cancer [20–22]. Our study confirmed this point as overall detection rate was higher using the combined blue dye/radiotracer method.
Radioguided surgery: New applications, approaches, and strategies
2022, Nuclear Oncology: From Pathophysiology to Clinical Applications