The sentinel node procedure in early XXXX , taking the next step; a diagnostic review.

@entity5 @entity1 @entity9217 @entity3846
OBJECTIVE: Recent reviews on the sentinel lymph node (SLN) procedure in cervical @entity5 have shown that bilateral SLN detection and ultra staging are safe and superior options compared to a unilateral detection, frozen section and H_E analysis. So far, nobody identified a subgroup of @entity1 in whom a SLN procedure may replace pelvic lymph node dissection (PLND). METHODS: We searched PubMed, Embase, CINAHL and Cochrane from inception up to November 26, 2014. Studies reporting SLN detection, and/or histological outcome of the SLN were included. Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool by two independent reviewers. Data to complete 2*2 contingency tables were obtained, and @entity1 -, study- and technique characteristics were extracted. Results were pooled and plotted in forest plots. RESULTS: Forty-seven studies (4130 @entity1 ) were analyzed. Pooled data of diagnostic accuracy on ultra staging (18 studies; 1275 @entity1 ) showed a sensitivity of 94% (95% CI 80-99%) and negative predictive values ranging between 91 and 100%. After ultra staging, 19 false negative results remained. Prerequisites such as early FIGO stage ( @entity9217 , @entity3846 , IIA @entity5 size <40mm), no suspicious pre-, and per-operative lymph nodes, and bilateral negative SLNs after ultra staging resulted in 1 remaining false negative result among 1257 @entity1 (0.08%). Pooled data on a combined tracer in early @entity5 @entity1 with @entity5 size <20mm (6 studies; 276 @entity1 ) resulted in 87% bilateral SLN detection. CONCLUSIONS: Early @entity5 @entity1 (FIGO @entity9217 , @entity3846 , IIA @entity5 size <40mm) who have no suspicious pre-, and per-operative lymph nodes, and have bilateral negative SLNs after ultra staging, have a residual risk of 0.08% (1/1257) on occult metastases. On the basis of these results we recommend not to perform a full PLND in these @entity1 .
