Warren Sun, MD1, Jerry T Dang, MD1, Aryan Modasi, MD, FRCSC1, Awrad Nasralla, MD1, Daniel Skubleny, MD1, Noah J Switzer, MD, MPH, FRCSC2, Daniel Birch, MD, MSc, FRCSC1, Simon Turner, MD, FRCSC1, Shahzeer Karmali, MD, MPH, FRCSC1. 1University of Alberta, 2Ohio State University Wexner Medical Center
INTRODUCTION: We aim to systematically review the literature and perform a meta-analysis on the diagnostic utility of ICG for SNNS in lung cancer. Lung cancer is the leading cause of cancer death worldwide. The use of sentinel node navigation surgery (SNNS) is well established in the literature to reduce operative mortality in cancers. Indocyanine green (ICG) has also been reported as an emerging technology in SNNS.
METHODS AND PROCEDURES: A comprehensive search of MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms “lung/pulmonary” AND “tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy/ squamous/carcinoid” AND “indocyanine green” was completed in June 2018. Studies were limited to humans and English. 347 titles or abstracts were screened. Articles were selected by two independent reviewers based on the following inclusion criteria: (1) diagnostic accuracy study design; (2) ICG injected at the tumor site; (3) lymphadenectomy or systematic lymph node sampling was performed as gold standard.
RESULTS: Nine primary studies were included with a total of 382 patients. 43.0% of patients were females, and the mean tumor size was 2.3 cm. Additionally, 33.9% of tumors were located in the RUL, 5.3% in the RML, 17.2% in the RLL, 26.0% in the LUL, and 17.6% in the LLL. Pathologic analysis revealed 67.5% of tumors were adenocarcinomas, 21.3% were squamous cell carcinomas, 10.6% were other malignancies, and 0.6% were other benign tumors. Furthermore, 6.9% of patients received wedge resections, 48.0% received segmentectomies, 39.3% received lobectomies, and 5.8% received pneumonectomies. Sentinel node biopsies were successful in 298 patients, yielding a pooled identification rate of 0.75 (0.56 to 0.90). A meta-analysis of seven studies computed a diagnostic odds ratio, sensitivity, and specificity of 177.61 (45.64 to 691.14), 0.85 (0.71 to 0.94), and 1.00 (0.98 to 1.00), respectively. The summary receiver operator characteristic (SROC) demonstrated an AUC of 0.963 (SE = 0.038) and a Q* of 0.909 (SE = 0.057). Only 59.5% of patients with histologically positive sentinel nodes had metastatic disease exclusively in the sentinel nodes.
CONCLUSION: Our review found suboptimal results for the use of ICG in SNNS for lung cancer. The diagnostic odds ratio, sensitivity, and SROC AUC were promising, but needs improvement before consideration as a potential treatment option for lung cancer. This was due to a mediocre identification rate, and a poor representation of all metastatic nodes. Further research is required to develop a robust protocol for the use of ICG in SNNS for lung cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95454
Program Number: P693
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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