Diagnostic accuracy of sentinel lymph node biopsy using indocyanine green in lung cancer: a systematic review and meta-a
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REVIEW ARTICLE
Diagnostic accuracy of sentinel lymph node biopsy using indocyanine green in lung cancer: a systematic review and meta‑analysis Warren Y. L. Sun1 · Jerry T. Dang1 · Aryan Modasi2 · Awrad Nasralla1 · Noah J. Switzer1,2 · Daniel Birch1,2 · Simon R. Turner3 · Shahzeer Karmali1,2 Received: 23 April 2020 / Accepted: 4 June 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective The use of sentinel lymph node biopsy (SLNB) has been gaining popularity with the emergence of indocyanine green (ICG) fluorescence imaging. We aimed to systematically review the literature and perform a meta-analysis on the diagnostic accuracy of SLNB using ICG for lung cancer. Methods A comprehensive search of MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms “lung/pulmonary” AND “tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy/squamous/carcinoid” AND “indocyanine green” was completed in June 2018. Articles were selected based on the following inclusion criteria: (1) diagnostic accuracy study design; (2) ICG injected at the tumor site with near-infrared fluorescence imaging identification of sentinel lymph nodes; (3) lymphadenectomy or sampling was performed as the gold standard. Results Eight primary studies were included with a total of 366 patients. 43.0% of patients were females and the mean tumor size was 2.3 cm. Sentinel lymph nodes were identified with ICG in 251 patients, yielding a pooled identification rate of 0.83 (0.67–0.94). A meta-analysis of seven studies computed a diagnostic odds ratio, sensitivity, and specificity of 177.6 (45.6–691.1), 0.85 (0.71–0.94), and 1.00 (0.98–1.00), respectively. The summary receiver operator characteristic demonstrated an area under the curve of 0.963 (SE = 0.038) and a Q* of 0.91 (SE = 0.057). Conclusion Our review found suboptimal results for the diagnostic accuracy of SLNB using ICG and must be improved before routine clinical use. Further research is required to develop a robust protocol for the use SLNB with ICG for lung cancer. Keywords Indocyanine green · Sentinel lymph node · Lung cancer
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01400-8) contains supplementary material, which is available to authorized users. * Warren Y. L. Sun [email protected] 1
Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 ‑ 112 ST NW, Edmonton, AB 2G2 T6G 2B7, Canada
2
Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
3
Division of Thoracic Surgery, University of Alberta, Edmonton, AB, Canada
The importance of systematic lymph node assessment during curative resection for non-small cell lung cancer (NSCLC) is critical, as the detection of nodal disease during cancer resection can dictate whether a patient receives adjuvant therapy, which may significantly alter survival [1–5]. While the extent of lymph node assessment has been debated rigorously [6
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