title: Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature.
abstract: BACKGROUND
  We reviewed the available literature on the accuracy of sentinel node mapping in the lymph nodal staging of uterine cervical cancers.
  
  
  METHODS
  MEDLINE and Scopus were searched by using "sentinel AND (cervix OR cervical)" as key words. Studies evaluating the accuracy of sentinel node mapping in the lymph nodal staging of uterine cervical cancers were included if enough data could be extracted for calculation of detection rate and/or sensitivity.
  
  
  RESULTS
  Sixty-seven studies were included in the systematic review. Pooled detection rate was 89.2% [95% CI: 86.3-91.6]. Pooled sensitivity was 90% [95% CI: 88-92]. Sentinel node detection rate and sensitivity were related to mapping method (blue dye, radiotracer, or both) and history of pre-operative neoadjuvant chemotherapy. Sensitivity was higher in patients with bilaterally detected pelvic sentinel nodes compared to those with unilateral sentinel nodes. Lymphatic mapping could identify sentinel nodes outside the routine lymphadenectomy limits.
  
  
  CONCLUSIONS
  Sentinel node mapping is an accurate method for the assessment of lymph nodal involvement in uterine cervical cancers. Selection of a population with small tumor size and lower stage will ensure the lowest false negative rate. Lymphatic mapping can also detect sentinel nodes outside of routine lymphadenectomy areas providing additional histological information which can improve the staging. Further studies are needed to explore the impact of sentinel node mapping in fertility sparing surgery and in patients with history of neoadjuvant chemotherapy.
authors.affiliation: Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Kadkhodayan
authors.affiliation: Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Hasanzadeh
authors.affiliation: Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Treglia
authors.affiliation: Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Azad
authors.affiliation: Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Z
authors.initials: Z
authors.lastname: Yousefi
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: L
authors.initials: L
authors.lastname: Zarifmahmoudi
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: sadeghir@mums.ac.ir.
authors.forename: R
authors.initials: R
authors.lastname: Sadeghi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Cervical cancer; Evidence based; Lymphatic mapping; Meta-analysis; Sentinel node