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Sectioning protocol determines accuracy of intraoperative pathological examination of sentinel lymph node in cervical cancer : A systematic review and meta-analysis

Tu, Hua ; Gu, Hai Feng ; Huang, He ; Liu, Kai Jiang ; Yun, Jing Ping ; Chen, Jie Ping ; Zhang, Xin Ke ; Yahata, Hideaki ; Sonoda, Kenzo and Zhang, Hao Yang LU orcid , et al. (2020) In Gynecologic Oncology 158(2). p.489-497
Abstract

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... (More)

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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publishing date
type
Contribution to journal
publication status
published
keywords
Cervical cancer, Frozen section, Meta-analysis, Metastasis, Sensitivity, Sentinel lymph node
in
Gynecologic Oncology
volume
158
issue
2
pages
489 - 497
publisher
Academic Press
external identifiers
  • pmid:32507651
  • scopus:85086020996
ISSN
0090-8258
DOI
10.1016/j.ygyno.2020.05.037
language
English
LU publication?
no
additional info
Publisher Copyright: © 2020 Elsevier Inc.
id
3f194d60-b6aa-436d-9ed3-2d73cd91f3a1
date added to LUP
2024-02-05 15:57:20
date last changed
2024-04-09 13:10:24
@article{3f194d60-b6aa-436d-9ed3-2d73cd91f3a1,
  abstract     = {{<p>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 (I<sup>2</sup> = 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 &lt; 0.001). The pooled sensitivity was 0.86 (95% CI 0.79–0.91, I<sup>2</sup> = 0%) and 0.59 (0.46–0.72, I<sup>2</sup> = 58.47%) for FSE using L- (13 studies, 650 patients) and E- (13 studies, 1047 patients) protocol, respectively. Among the available data, marcometastases (&gt;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.</p>}},
  author       = {{Tu, Hua and Gu, Hai Feng and Huang, He and Liu, Kai Jiang and Yun, Jing Ping and Chen, Jie Ping and Zhang, Xin Ke and Yahata, Hideaki and Sonoda, Kenzo and Zhang, Hao Yang and Liu, Ji Hong}},
  issn         = {{0090-8258}},
  keywords     = {{Cervical cancer; Frozen section; Meta-analysis; Metastasis; Sensitivity; Sentinel lymph node}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{489--497}},
  publisher    = {{Academic Press}},
  series       = {{Gynecologic Oncology}},
  title        = {{Sectioning protocol determines accuracy of intraoperative pathological examination of sentinel lymph node in cervical cancer : A systematic review and meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ygyno.2020.05.037}},
  doi          = {{10.1016/j.ygyno.2020.05.037}},
  volume       = {{158}},
  year         = {{2020}},
}