Meta-analysis Of Sentinel Lymph Node Biopsy In Papillary Thyroid Carcinoma

Objective:To study the reported viable sentinel lymph node biopsy methods for papillary thyroid carcinoma(PTC),such as: vital blue dye(VB),nano carbon(NC),99 m Tc-nano colloidal lymphography combined with intraoperative use of hand-held gamma Detector(LS),99 m Tc-nano-colloid lymphography with hand-held gamma probe and vital blue dye(LS+VB)during surgery,99 m Tc-nano-colloid lymphography with hand-held gamma probe and surgery The single-photon emission computed tomography(LS-SPECT)was used before.Compare the sentinel node detection rate(SDR)and false negative rate(FNR)to evaluate the diagnostic effect of each method.Methods: We use computer search tools,search the pubmed database,the Cochrane database,China Knowledge Network(CNKI)and Wanfang database with "papillary thyroid carcinoma","sentinel lymph node" and related free words as search terms.Collect all relevant literature on sentinel lymph node biopsy of papillary thyroid carcinoma published between January2000 and December 2020.After screening and quality evaluation according to the inclusion and exclusion criteria,data analysis was performed using Stata/SE 16.0 software.Results: A total of 31 articles were included in this study,and a total of1977 subjects were included in this study.Meta analysis results showed: the extraction rate of vital blue dye(VB): 90%,95% CI [0.87;0.94];false negative rate: 16%,95% CI [0.10;0.22].Nano carbon(NC)extraction rate:93%,95% CI [0.79;1.00];false negative rate: 12%,95% CI [0.02;0.29].The extraction rate of 99 m Tc-nano-colloid lymphography with the use of a handheld gamma detector(LS)during the operation: 99%,95% CI [0.79;1.00],false negative rate: 17%,95% CI [0.02;0.40].99 m Tc-nano-colloid lymphography combined with hand-held gamma probe and vital blue dye(LS+VB)extraction rate: 99%,95%CI[0.96;1.00],false negative rate: 8%,95%CI [0.03;0.15].99 m Tc-nano-colloid lymphography combined with intraoperative use of handheld gamma probe and preoperative use of single photon emission computed tomography(LS-SPECT)extraction rate: 91%,95% CI [0.85;0.96],false negative Rate: 10%,95% CI [0.05;0.18].The total detection rate was 92%,95% CI [0.87;0.96],and the total false negative rate was 13%,95% CI [0.09;0.18].Conclusions:Sentinel lymph node detection is generally safe and feasible.In the traditional dye method,the new lymph node tracer nanocarbon has a lower incidence of postoperative complications than the living body blue dye.The detection technology based on the use of radioisotopes has a high SDR.The combined use of nuclide and dye method can obtain higher SDR and lower false negative rate.However,it is still necessary to clarify the definition of SLN in surgical biology to help surgeons decide which lymph nodes should be removed,so as to determine the true biological SLN to the greatest extent and minimize the unnecessary resection of non-SLN.At the same time,the diagnosis technology should be improved accordingly to reduce the false negative rate and reduce the missed diagnosis.