title: Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis.
abstract: BACKGROUND
  The purpose of this study was to determine the accuracy of sentinel lymph node (SLN) biopsy with technetium 99 (99mTc) and/or blue dye-enhanced lymphoscintigraphy in vulval cancer.
  
  
  METHODS
  Sensitive searches of databases were performed upto October 2013. Studies with at least 75% of women with FIGO stage IB or II vulval cancer evaluating SLN biopsy with 99mTc, blue dye or both with reference standard of inguinofemoral lymphadenectomy (IFL) or clinical follow-up were included. Meta-analyses were performed using Meta-Disc version 1.4.
  
  
  RESULTS
  Of the 2950 references, 29 studies (1779 women) were included; most of them evaluated 99mTc combined with blue dye. Of these, 24 studies reported results for SLN followed by IFL, and 5 reported clinical follow-up only for SLN negatives. Pooling of all studies was inappropriate because of heterogeneity. Mean SLN detection rates were 94.0% for 99mTc, 68.7% for blue dye and 97.7% for both. SLN biopsy had pooled sensitivity of 95% (95% CI 92-98%) with negative predictive value (NPV) of 97.9% in studies using 99mTc/blue dye, ultrastaging and immunohistochemistry with IFL as reference. Pooled sensitivity for SLN with clinical follow-up for SLN-negatives was 91% (85-95%) with NPV 95.6%. Patients undergoing SLN biopsy experienced less morbidity than those undergoing IFL.
  
  
  CONCLUSIONS
  Sentinel lymph node biopsy using 99mTC, blue dye and ultrastaging with immunohistochemistry is highly accurate when restricted to carefully selected patients, within a rigorous protocol, with close follow-up and where sufficient numbers for learning curve optimisation exist. Patients must make an informed choice between the slightly higher groin recurrence rates of SLN biopsy vs the greater morbidity of IFL.
authors.affiliation: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Meads
authors.affiliation: Unit of Health Economics, University of Birmingham, Birmingham, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Sutton
authors.affiliation: Barts Cancer Institute, London, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Rosenthal
authors.affiliation: Arcana Institute, Kracow, Poland.
authors.forename: S
authors.initials: S
authors.lastname: Małysiak
authors.affiliation: Arcana Institute, Kracow, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Kowalska
authors.affiliation: Arcana Institute, Kracow, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Zapalska
authors.affiliation: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Rogozińska
authors.affiliation: Addenbrooke's Hospital NHS Trust, Cambridge, UK.
authors.forename: P
authors.initials: P
authors.lastname: Baldwin
authors.affiliation: Pan Birmingham Gynaecological Cancer Centre, City Hospital and School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ganesan
authors.affiliation: Barts Cancer Institute, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Borowiack
authors.affiliation: Unit of Health Economics, University of Birmingham, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Barton
authors.affiliation: Unit of Health Economics, University of Birmingham, Birmingham, UK.
authors.forename: T
authors.initials: T
authors.lastname: Roberts
authors.affiliation: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khan
authors.affiliation: Pan Birmingham Gynaecological Cancer Centre, City Hospital and School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sundar
mesh_terms: D004396:Coloring Agents; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D009364:Neoplasm Recurrence, Local; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013194:Staining and Labeling; D013667:Technetium; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013667:Technetium