Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: systematic review and meta-analysis of the literature.
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.
Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali
A
Taghizadeh Kermani
Reza
R
Bagheri
Shahrzad
S
Tehranian
Pardis
P
Shojaee
Ramin
R
Sadeghi
David
D
N Krag
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008482:Mediastinum / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods*; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*