TY - JOUR
T1 - Sectioning protocol determines accuracy of intraoperative pathological examination of sentinel lymph node in cervical cancer
T2 - A systematic review and meta-analysis
AU - Tu, Hua
AU - Gu, Hai Feng
AU - Huang, He
AU - Liu, Kai Jiang
AU - Yun, Jing Ping
AU - Chen, Jie Ping
AU - Zhang, Xin Ke
AU - Yahata, Hideaki
AU - Sonoda, Kenzo
AU - Zhang, Hao Yang
AU - Liu, Ji Hong
N1 - Funding Information:
HT and J-HL report being investigators of an ongoing multicenter trial regarding SLNB in cervical cancer (CSEM 010, NCT02642471) funded by a government project (Health and Medical Cooperation Innovation Special Program of Guangzhou Municipal Science and Technology, grant number: 158100075). All other authors declare no competing interests.
Funding Information:
We thank Prof Shingo Fujii (Kyoto University, Japan), Prof Aikou Okamoto (School of Medicine, Jikei University, Japan), Prof L?szl? Ung?r (Duna Medical Center, Budapest, Hungary), Prof Wei-Guo Lu (Women's Hospital, School of Medicine, Zhejiang University, China), and Dr. Liang Chen (Shandong Cancer Hospital, Shandong University, China) for their assistances in contacting the authors. We thank Prof Tomohito Tanaka (Osaka Medical College, Japan), Prof Yoshito Terai (Kobe University Graduate School of Medicine, Japan), Prof Robert P?ka (University of Debrecen, Hungary), and Prof Han-Mei Lou (Zhejiang Cancer Hospital, Zhejiang University, China) for their works and patience in re-examining the pathological data of their patients. We thank all the respondents in our questionnaire survey no matter whether they provided eligible data. This study was funded by Health and Medical Cooperation Innovation Special Program of Guangzhou Municipal Science and Technology (grant number: 158100075). This work was supported by the Health and Medical Cooperation Innovation Special Program of Guangzhou Municipal Science and Technology (grant number: 158100075). HT and J-HL designed the study and wrote the manuscript. HT and H-FG wrote and registered the study protocol. H-FG and HH developed the search strategy and completed the literature search. HT and J-HL formulated the definitions for pathological protocols, designed the questionnaire survey, and contacted the authors. HT, H-FG, HH and J-HL reviewed the literature search results and extracted data. J-PC and H-YZ did the quality assessment. J-PC, X-KZ, and J-PY did the methodological judgement. H-FG, HH and H-YZ developed the statistical analysis methods. K-JL, HY, and KS provided original data. All authors reviewed the manuscript and provided contributions to the interpretation of the data. HT and J-HL report being investigators of an ongoing multicenter trial regarding SLNB in cervical cancer (CSEM 010, NCT02642471) funded by a government project (Health and Medical Cooperation Innovation Special Program of Guangzhou Municipal Science and Technology, grant number: 158100075). All other authors declare no competing interests.
Funding Information:
We thank Prof Shingo Fujii (Kyoto University, Japan), Prof Aikou Okamoto (School of Medicine, Jikei University, Japan), Prof László Ungár (Duna Medical Center, Budapest, Hungary), Prof Wei-Guo Lu (Women's Hospital, School of Medicine, Zhejiang University, China), and Dr. Liang Chen (Shandong Cancer Hospital, Shandong University, China) for their assistances in contacting the authors. We thank Prof Tomohito Tanaka (Osaka Medical College, Japan), Prof Yoshito Terai (Kobe University Graduate School of Medicine, Japan), Prof Robert Póka (University of Debrecen, Hungary), and Prof Han-Mei Lou (Zhejiang Cancer Hospital, Zhejiang University, China) for their works and patience in re-examining the pathological data of their patients. We thank all the respondents in our questionnaire survey no matter whether they provided eligible data. This study was funded by Health and Medical Cooperation Innovation Special Program of Guangzhou Municipal Science and Technology (grant number: 158100075 ).
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Objectives: To determine the diagnostic performance and optimal protocol of frozen section examination (FSE) in SLNB for cervical cancer. Methods: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure were searched from inception to July 30, 2019, for studies concerning SLNB with FSE in cervical cancer. Sensitivity of FSE in detecting SLN metastasis was the primary diagnostic indicator for evaluation. Results: The pooled sensitivity of FSE among 31 eligible studies (1887 patients) was 0.77 (95% CI 0.66–0.85) with high heterogeneity (I2 = 69.73%). Two representative sectioning protocols for FSE were identified from 26 studies, described as equatorial (E-protocol, SLN was bisected) and latitudinal (L-protocol, SLN was cut at intervals). Meta-regression showed that FSE protocol was the only source of heterogeneity (p < 0.001). The pooled sensitivity was 0.86 (95% CI 0.79–0.91, I2 = 0%) and 0.59 (0.46–0.72, I2 = 58.47%) for FSE using L- (13 studies, 650 patients) and E- (13 studies, 1047 patients) protocol, respectively. Among the available data, marcometastases (>2 mm) were missed in 4 and 20 patients; small-volume metastases (≤2 mm) were detected in 13 and 2 patients, respectively, under L- and E-protocol. The pooled sensitivity of FSE using L-protocol would reach 0.97 (95% CI 0.89–0.99) if only marcometastases were considered. These findings were robust to sensitivity analyses. Conclusion: The sectioning protocol determines the accuracy of FSE in SLNB. With L-protocol, FSE can provide precise intraoperative pathology for SLNB, which enables immediate decision-making for individualized managements.
AB - Objectives: To determine the diagnostic performance and optimal protocol of frozen section examination (FSE) in SLNB for cervical cancer. Methods: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure were searched from inception to July 30, 2019, for studies concerning SLNB with FSE in cervical cancer. Sensitivity of FSE in detecting SLN metastasis was the primary diagnostic indicator for evaluation. Results: The pooled sensitivity of FSE among 31 eligible studies (1887 patients) was 0.77 (95% CI 0.66–0.85) with high heterogeneity (I2 = 69.73%). Two representative sectioning protocols for FSE were identified from 26 studies, described as equatorial (E-protocol, SLN was bisected) and latitudinal (L-protocol, SLN was cut at intervals). Meta-regression showed that FSE protocol was the only source of heterogeneity (p < 0.001). The pooled sensitivity was 0.86 (95% CI 0.79–0.91, I2 = 0%) and 0.59 (0.46–0.72, I2 = 58.47%) for FSE using L- (13 studies, 650 patients) and E- (13 studies, 1047 patients) protocol, respectively. Among the available data, marcometastases (>2 mm) were missed in 4 and 20 patients; small-volume metastases (≤2 mm) were detected in 13 and 2 patients, respectively, under L- and E-protocol. The pooled sensitivity of FSE using L-protocol would reach 0.97 (95% CI 0.89–0.99) if only marcometastases were considered. These findings were robust to sensitivity analyses. Conclusion: The sectioning protocol determines the accuracy of FSE in SLNB. With L-protocol, FSE can provide precise intraoperative pathology for SLNB, which enables immediate decision-making for individualized managements.
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U2 - 10.1016/j.ygyno.2020.05.037
DO - 10.1016/j.ygyno.2020.05.037
M3 - Review article
C2 - 32507651
AN - SCOPUS:85086020996
SN - 0090-8258
VL - 158
SP - 489
EP - 497
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 2
ER -
