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Meta-Analysis
. 2022 Jan;5(1):e1401.
doi: 10.1002/cnr2.1401. Epub 2021 May 11.

Indocyanine green versus technetium-99m with blue dye for sentinel lymph node detection in early-stage cervical cancer: A systematic review and meta-analysis

Ilse G T Baeten  1 , Jacob P Hoogendam  1 , Bernadette Jeremiasse  2 , Arthur J A T Braat  3 , Wouter B Veldhuis  3 , Geertruida N Jonges  4 , Ina M Jürgenliemk-Schulz  5 , Carla H van Gils  6 , Ronald P Zweemer  1 , Cornelis G Gerestein  1
Affiliations
Meta-Analysis

Indocyanine green versus technetium-99m with blue dye for sentinel lymph node detection in early-stage cervical cancer: A systematic review and meta-analysis

Ilse G T Baeten et al. Cancer Rep (Hoboken). 2022 Jan.

Abstract

Background: The fluorescent dye indocyanine green (ICG) has emerged as a promising tracer for intraoperative detection of sentinel lymph nodes (SLNs) in early-stage cervical cancer. Although researchers suggest the SLN detection of ICG is equal to the more conventional combined approach of a radiotracer and blue dye, no consensus has been reached.

Aims: We aimed to assess the differences in overall and bilateral SLN detection rates with ICG versus the combined approach, the radiotracer technetium-99m (99m Tc) with blue dye.

Methods and results: We searched MEDLINE, Embase, and the Cochrane Library from inception to January 1, 2020 and included studies reporting on a comparison of SLN detection with ICG versus 99m Tc with blue dye in early-stage cervical cancer. The overall and bilateral detection rates were pooled with random-effects meta-analyses. From 118 studies retrieved seven studies (one cross-sectional; six retrospective cohorts) were included, encompassing 589 patients. No significant differences were found in the pooled overall SLN detection rate of ICG versus 99m Tc with blue dye. Meta-analyses of all studies showed ICG to result in a higher bilateral SLN detection rate than 99m Tc with blue dye; 90.3% (95%CI, 79.8-100.0%) with ICG versus 73.5% (95%CI, 66.4-80.6%) with 99mTc with blue dye. This resulted in a significant and clinically relevant risk difference of 16.6% (95%CI, 5.3-28.0%). With sensitivity analysis, the risk difference of the bilateral detection rate maintained in favor of ICG but was no longer significant (13.2%, 95%CI -0.8-27.3%).

Conclusion: ICG appears to provide higher bilateral SLN detection rates compared to 99m Tc with blue dye in patients with early-stage cervical cancer. However, in adherence with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, the quality of evidence is too low to provide strong recommendations and directly omit the combined approach of 99m Tc with blue dye.

Keywords: cervical cancer; indocyanine green; meta-analysis; sentinel lymph node; technetium-99 m nanocolloid.

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Conflict of interest statement

R.Z. is a proctor for robot‐assisted surgery in gynecological oncology on behalf of Intuitive Surgical Inc. C.v.G. reports grants and other from Bayer Pharma, all outside the submitted work. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart
FIGURE 2
FIGURE 2
Forest plots primary analysis. Pooled risk differences in overall SLN detection (A) and bilateral SLN detection (B) of ICG versus 99mTc with blue dye (BD)
FIGURE 3
FIGURE 3
Funnel plots of overall SLN detection (A) and bilateral SLN detection (B)
FIGURE 4
FIGURE 4
Forest plots sensitivity analysis. Pooled risk differences in overall SLN detection (A) and bilateral SLN detection (B) of ICG versus 99mTc with blue dye (BD)
See this image and copyright information in PMC

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