title: Is the sentinel node biopsy clinically applicable for limited lymphadenectomy and modified gastric resection in gastric cancer? A meta-analysis of feasibility studies.
abstract: BACKGROUND
  Sentinel node biopsies (SNBs) have been clinically applied in melanoma and breast cancer for limited lymphadenectomy. However, the use of SNB remains controversial in gastric cancer due to unsatisfactory sensitivity and variability. This meta-analysis was performed to determine the sensitivity of SNB in gastric cancer and to identify factors that improve its sensitivity.
  
  
  METHODS
  Feasibility studies on SNB in gastric cancer were searched for from 2001 to 2009 in Pubmed, Cochrane, and Embase. Forty-six reports, which included 2,684 patients, were found. Estimated sensitivities, detection rates, and negative (NPV), and positive predictive values (PPV) were calculated using a random effects model. Inter-study heterogeneity, meta-regression, and subgroup analysis for sensitivity was performed.
  
  
  RESULTS
  The estimated sensitivity, detection rate, NPV, and PPV were 87.8%, 97.5%, 91.8%, and 38.0%, respectively, with significant inter-study heterogeneity (P < 0.0001). However, no significant contributor to heterogeneity was identified. By subgroup analysis, sensitivity was found to depend significantly on the number of SNs harvested.
  
  
  CONCLUSIONS
  SNB in gastric cancer is probably not clinically applicable for limited lymphadenectomy due its unsatisfactory sensitivity and heterogeneity between practicing surgeons. To improve sensitivity, more than four SNs should be harvested, and a tumor specific SNB method should be developed.
authors.affiliation: Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.forename: Bang Wool
authors.initials: BW
authors.lastname: Eom
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Myeong Cherl
authors.initials: MC
authors.lastname: Kook
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D008197:Lymph Node Excision; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome