Performance of Indocyanine Green Fluorescence for Detecting Lymph Node Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis |
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| Institution: | 1. Department of Urology, Jikei University School of Medicine, Tokyo, Japan;2. Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan;1. Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy;2. Department of Medicine and Health Sciences “Vincenzo Tiberio,” University of Molise, Campobasso, Italy;3. Department of Oncology, Hospital “Andrea Tortora,” ASL Salerno, Pagani, Italy;4. Department of Oncology and Hematology, AOU Federico II of Naples, Naples, Italy;5. Department of Precision Medicine, University of Campania “L. Vanvitelli,” Naples, Italy;6. Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy;7. Regional Reference Center for Rare Tumors, Department of Oncology and Hematology, AOU Federico II of Naples, Naples, Italy;8. Department of Public Health, University of Naples “Federico II,” Naples, Italy;9. Division of Urology, European Institute of Oncology-IRCCS, Milan, Italy;10. Medical Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy;11. Departmental Unit of Experimental Uro-Andrological Clinical Oncology, Department of Uro-Gynaecological Oncology, National Cancer Institute–IRCCS–G. Pascale Foundation, Naples, Italy;12. Biogem Scarl, Institute of Genetic Research, Laboratory of Precision Medicine and Molecular Oncology, Ariano Irpino, Italy;1. Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;2. Genitourinary Oncology Service, Weill Cornell Medicine, New York, NY;3. Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;4. Urologic Oncology Service, University of North Carolina, Chapel Hill, North Carolina;5. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY |
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| Abstract: | Purpose: The use of sentinel lymph node dissection in several cancers has been gaining attention with the emergence of indocyanine green fluorescence. We performed a meta-analysis to assess the diagnostic performance of indocyanine green fluorescence in detecting lymph node metastasis in prostate cancer patients.Methods: A literature search was conducted using PubMed, Cochrane Library, and SCOPUS on November 30, 2020, to identify eligible studies. Studies were eligible if they investigated the diagnostic performance of indocyanine green fluorescence before pelvic lymph node dissection in prostate cancer patients and reported the number of true positives, false positives, false negatives, and true negatives on lymph node–based analysis in comparison to histopathologic findings in the dissected specimen.Results: Our systematic review covered 11 studies published between 2011 and 2020, with 519 patients, and our meta-analysis included 9 studies with 479 patients. Based on lymph node analysis of indocyanine green fluorescence, the results showed pooled sensitivity and specificity at 0.75 (95% confidence interval CI] 0.49 to 0.90) and 0.66 (95% CI 0.61 to 0.70), respectively. The diagnostic odds ratio was 6.0 (95%CI 2 to 21). Several lymphatic drainage routes also showed sentinel lymph nodes localized outside the ordinal pelvic lymph node template.Conclusions: We noted relatively low diagnostic performance for lymph node metastasis, suggesting that indocyanine fluorescence may not currently be a viable alternative to pelvic lymph node dissection in prostate cancer patients. However, this technique shows novel lymphatic drainage routes and underscores the importance of lymph nodes not removed in ordinary dissection. |
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| Keywords: | Lymph node metastasis |
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