| Background:Traditionally, treatment for squamous cell carcinoma of the vulva has included radical local vulvectomy or radical vulvectomy plus inguinofemoral lymph node dissection(IFLD). Groin lymph node status has been identified as the most important factor in predicting mortality attributable to vulvar cancer. The efficacy of this treatment is good, with reported groin recurrence rates varying between 1% and 10%. However, less than a third of patients with early-stage disease will have lymph node metastases, and the remainder will not benefit from elective IFLD while risking significant morbidity. The application of sentinel lymph node biopsy(SLNB)may be expected to solve this problem. in the future. The sentinel lymph node(SLN) is the first regional lymph node that directly drains the lymph from the primary tumor, and is considered the first node to receive lymph-borne metastatic cancer cells. Thereforeit has the highest probability of containing metastatic disease. The feasibility of the SLNB procedure has already been validated in cutaneous melanoma and breast cancer. SLNB is a newer, less invasive surgical technique for women with early stage vulvar cancer. The SNLB may be a reasonablealternative to unnecessary extensive groin dissections and reliable methodfor surgical control of early stage vulvar cancer in the future.Objective:To systematically reviewed the clinical value of sentinel lymph node biopsy in the diagnosis of inguinal lymph node metastases in early stage vulvar cancer.Methods:Relevant studies were identified by systematically searching CJFD,CBM,CNKI,WANGFANG,WEIPU, Pub Med,Medline,OVID,Embase,Google Scholar and Cochrane library,time from January 1990 to December2015. SLNB application wasconcerned in early stage vulvar cancer. Literatures were filtrated according to inclusive and exclusive criteria,analyzed by Meta-analysis software Meta Disc 1.4.Results:A total of 641 literatures were obtained,out of which 31 were eligible for analysis. Thirty were in English and one was in Chinese,including 1634 patients with early-stage squamous cell carcinoma of vulva.No significant heterogeneity was found among the results of enrolled studies,when we reviewed them in patient basis analysis.The data were pooled by fixed effect model,and the pooled sensitivity and specificity were 0.92( 95%CI : 0.89-0.94)、 1.00( 95%CI : 1.00-1.00),respectively. The calculated area under curve(AUC)of Summary Receiver Operating Characteristic(SROC)and Q* were 0.9875 and 0.9526, respectively. Subgroup analysis showed that the pooled sensitivity of SLNB were 0.87(95%CI:0.76-0.94)、0.86(95%CI:0.57-0.98)、0.90(95%CI:0.83-0.95)in studies using radiotracer alone、blue dye alone and combined tracers,respectively. No significant heterogeneity was found among the results of enrolled studies,when we reviewed them in groin basis analysis, too.The data were pooled by fixed effect model,and the pooled sensitivity and specificity were 0.91(95%CI:0.88-0.94)、1.00(95%CI:1.00-1.00),respectively.The calculated area under curve(AUC)of summarized Receiver Operating Characteristic(ROC)and Q* were 0.9909 and 0.9607, respectively. Subgroup analysis showed that the pooled sensitivity of SLNB were 0.87(95%CI:0.76-0.94)、0.78(95%CI:0.61-0.90)、0.92(95%CI:0.86-0.96)in studies using radiotracer alone 、 blue dye alone and combined tracers,respectively.Conclusions:Whether on the patient basis or on the groin basis,SLNB is a highly accurate technique for diagnosis of inguinal lymph node metastases in early stage carcinoma of vulva.Pooled sensitivity for SLN with radiotracer alone was a little higher than with the blue dye alone. Combining radiotracer and blue dye methods shows the highest sensitivity among the three methods. |
PDF Full Text Request