Detection of sentinel lymph node in vulvar cancer using 99mTc-labeled colloid lymphoscintigraphy, blue dye, and indocyanine-green fluorescence: a meta-analysis of studies published in 2010–2020

• Published in: Archives of gynecology and obstetrics 2023-06, Vol.307 (6), p.1677-1686
• Main Authors: Di Donna, Mariano Catello, Quartuccio, Natale, Giallombardo, Vincenzo, Sturiale, Letterio, Arnone, Annachiara, Ricapito, Rosaria, Sozzi, Giulio, Arnone, Gaspare, Chiantera, Vito
• Format: Article
• Language: English
• Subjects: Endocrinology; Genital cancers; Gynecology; Human Genetics; Lymphatic system; Medicine; Medicine & Public Health; Meta-analysis; Obstetrics/Perinatology/Midwifery; Review; Tomography
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06605-1

Objectives Sentinel lymph node (SLN) biopsy is widely accepted in the surgical staging of early vulvar cancer, although the most accurate method for its identification is not yet defined. This meta-analysis aimed to determine the technique with the highest pooled detection rate (DR) for the identification of SLN and compare the average number of SLNs detected by planar lymphoscintigraphy (PL), single-photon emission computed tomography/computed tomography (SPECT/CT), blue dye and indocyanine green (ICG) fluorescence. Methods The meta-analysis was conducted according to the PRISMA guideline. The search string was: “sentinel” and “vulv*”, with date restriction from 1st January 2010 until Dec 31st, 2020. Three investigators selected studies based on: (1) a study cohort or a subset of a minimum of 10 patients with vulvar cancer undergoing either PL, SPECT/CT, blue-dye, or ICG fluorescence for the identification of SLN; (2) the possibility to extrapolate the DR or the average number of SLNs detected by a single technique (3) no evidence of other malignancies in the patient history. Results A total of 30 studies were selected. In a per-patient and a per-groin analysis, the DR for SLN of PL was respectively 96.13% and 92.57%; for the blue dye was 90.44% and 66.21%; for the ICG, the DR was 91.90% and 94.80%. The pooled DR of SPECT/CT was not calculated, since only two studies were performed in this setting. At a patient-based analysis, no significant difference was documented among PL, blue dye, and ICG ( p  = 0.28). At a per-groin analysis, PL and ICG demonstrated a significantly higher DR compared to blue dye ( p