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MINERVA UROLOGICA E NEFROLOGICA

Rivista di Nefrologia e Urologia


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Minerva Urologica e Nefrologica 2017 Dec 14

DOI: 10.23736/S0393-2249.17.02932-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Indocyanine green fluorescence-guided sentinel lymph node identification in urologic cancers: a systematic review and meta-analysis

Fouad AOUN 1, 2, Simone ALBISINNI 1, 3 , Marc ZANATY 2, Toufic HASSAN 2, Gunter JANETSCHEK 4, Roland van VELTHOVEN 1

1 Institut Jules Bordet, Department of Urology, Université Libre de Bruxelles, Bruxelles, Belgium; 2 Hotel Dieu De France, Department of Urology, Beirut, Lebanon; 3 Erasme Hospital, Department of Urology, Université Libre de Bruxelles, Bruxelles, Belgium; 4 Paracelsus Medical University Salzburg, Salzburg, Austria


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INTRODUCTION: To date, bilateral pelvic lymph node dissection (PLND) represents the most accurate and reliable staging procedure for the detection of lymph node invasion in prostate cancer and bladder cancer. However, the procedure is not devoid of complications. In this field, Indocyanine green fluorescence-guided sentinel lymph node (SLN) identification is an emerging and promising technique, as accurate staging of urologic cancer could be enhanced by a thorough evaluation of the sentinel lymph nodes. Aim of the present review is to analyze available evidence and perform a metanalysis on ICG-guided SLN detection for urologic malignancies.
EVIDENCE ACQUISITION: A systematic review to assess the clinical value of Indocyanine green for the identification of sentinel lymphatic drainage for bladder, prostate, kidney and penile cancers was undertaken, with a meta-analysis to generate pooled detection rate concerning patients (clinical sensitivity) and nodes basin (technical sensitivity) separately. Studies reporting on the use of Indocyanine green for the detection of SLNs from the bladder, prostate and penile cancers were included.
EVIDENCE SYNTHESIS: A total of 10 clinical trials were included. Using the fixed effects model and the random effects model, the pooled patient detection rates and their 95% confidence intervals (95% CI) were 0.88 (0.82-0.92) and 0.92 (0.84-0.96), respectively. The pooled nodes detection rates were 0.71 (95% CI: 0.68-0.74) using the fixed effect model and 0.75 (95% CI: 0.56-0.87) using the random effect model. Significant heterogeneities existed among studies for patients and for nodes (I2 = 0.66, p<0.001 and I2 = 0.96, p<0.001, respectively). Significant publication bias was found in patient detection rate (p<0.001) and in nodes detection rate (p<0.001).
CONCLUSIONS: SLN mapping in bladder and prostate cancer is a method with a high detection rate, although its specificity to predict LN invasion remains poor. Large well constructed trails are needed to assess the impact of ICG-fluorescence guided SLN dissection on uro-oncologic surgery.


KEY WORDS: Bladder - Penis - Prostate - Lymph node - Sentinel

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Publication History

Article first published online: December 14, 2017
Manuscript accepted: December 1, 2017
Manuscript revised: November 8, 2017
Manuscript received: March 19, 2017

Per citare questo articolo

Aoun F, Albisinni S, Zanaty M, Hassan T, Janetschek G, van Velthoven R. Indocyanine green fluorescence-guided sentinel lymph node identification in urologic cancers: a systematic review and meta-analysis. Minerva Urol Nefrol 2017 Dec 14. DOI: 10.23736/S0393-2249.17.02932-0

Corresponding author e-mail

Simone.albisinni@erasme.ulb.ac.be