Table 2.
Characteristics of included studies.
| Author | Year | Study Size | Study Method | Cancer Histology | Tracer Used | Injection Site | Route of Surgery | Reference Standard | Pathology Assessment |
|---|---|---|---|---|---|---|---|---|---|
| E. Barranger | 2004 | 17 | Prospective | All | Patent Blue and Tc-99m | Cervical | Laparoscopic | Systematic pelvic lymphadenectomy, para-aortic lymphadenectomy was performed when a para-aortic SN was detected or when positive SNs were found by intraoperative histological examination | H&E, IHC、ultrastaging |
| H. Niikura | 2004 | 28 | NR | All | Tc-99m | Uterine | Open | Pelvic and paraaoPrtic lymphadenectomy | H&E, IHC、ultrastaging |
| C. Altgassen | 2007 | 25 | Prospective | All | Blue dye | Uterine | Open | Depending on tumor size (>2 cm), grading (>G1) and invasion (>Ia) a complete pelvic lymphadenectomy was performed. A para-aortic lymphadenectomy followed if the general state of the patient was considered to be sufficient by the gynecologist and the anesthesiologist intra-operatively | H&E |
| L. A. Lopes | 2007 | 40 | NR | All | Patent Blue | Uterine | Open | Bilateral para-aortic and pelvic lymphadenectomies | H&E, IHC、ultrastaging |
| A. S. Bats | 2008 | 43 | Prospective | All | Tc-99m and blue dye | Cervical | Laparoscopic | Pelvic lymphadenectomy was performed with or without para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| Barranger E | 2009 | 33 | Prospective | All | Tc-99m and patent blue | Cervical | Laparoscopic | Laparoscopic bilateral pelvic lymphadenectomy | H&E, IHC、ultrastaging |
| J. How | 2012 | 100 | Prospective | All | Tc-99m and patent blue | Cervical | Robotic | Complete pelvic lymphadenectomy in all cases regardless of surgical pathology diagnosis. If the patient had a pre-operative type II endometrial cancer (clear cell, serous,adeno-squamous) or grade 2 or 3 endometrioid carcinomas, or carcinosarcoma, positive SLN on intra-operative frozen section, or grossly enlarged pelvic LNs suspicious for malignancy, the surgeon would continue with a para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| E. Solima | 2012 | 59 | Prospective | All | Tc-99m | Uterine | Open or Laparoscopic | Patients with one of the following criteria underwent systematic pelvic and paraaortic lymphadenectomy: 1) endometrioid adenocarcinoma with intraoperative staging equal to or higher than IBG2 (FIGO 1988); and 2) clear cell or serous carcinoma. All surgeries were performed by 4 senior gynecologists with proficiency in oncologic surgery, experienced in radio guided surgery in endometrial cancer. | H&E, IHC、ultrastaging |
| E. C. Rossi | 2013 | 29 | Prospective | All | ICG | Cervical & Uterine | Robotic | Bilateral pelvic and paraaortic lymphadenectomy | H&E 、 ultrastaging |
| A. Torné | 2013 | 74 | Prospective | All | Tc-99m | Uterine | Laparoscopic | Laparoscopic pelvic and paraaortic lymphadenectomy | H&E, IHC、ultrastaging |
| C. L. D. Cano | 2014 | 50 | Prospective | All | Tc-99m and blue dye | Cervical | Open or Laparoscopic | Pelvic and/or paraaortic lymphadenectomy | H&E 、 ultrastaging |
| E. Raimond | 2014 | 156 | Retrospective | All | Patent blue | Cervical | NR | Pelvic lymphadenectomy was systematically | H&E, IHC、ultrastaging |
| M. M. Farghali | 2015 | 93 | Retrospective | Endometrioid adenocarcinoma、Clear Cell Carcinoma 、Papillary serous carcinoma | Methylene blue dye | Uterine | Open | Pelvic and para-aortic lymphadenectomy. Extent of lymphadenectomy was decided by senior surgeon intra-operatively depending on grade of tumor, depth of invasion, size, location of endometrial carcinoma and patient`s fitness to such risky intervention | H&E, IHC、ultrastaging |
| G. Favero | 2015 | 42 | Prospective | Endometrioid adenocarcinoma、Serous papillary adenocarcinoma、Clear cell adenocarcinoma | Tc-99m | Uterine | Laparoscopic | Pelvic and Bpara-aortic lymphadenectomy | H&E |
| J. How | 2015 | 100 | Prospective | All | Tc-99m、ICGandBlue day | Cervical | Robotic | Pelvic lymphadenectomy. A para-aortic lymphadenectomy was per-formed if the patient had one or more of the following characteristics:pre-operative type II endometrial cancers (clear cell, serous, carcinosarcoma, or adenosquamous), grade 3 endometrioid carcinomas, positive SLN on intraoperative frozen section, or grossly enlarged para-aortic LNs suspicious for malignancy | H&E, IHC、ultrastaging |
| Naoura I | 2015 | 180 | Retrospective | All | Tc-99m and patent blue | Cervical | Open or Laparoscopic | SLN procedure completed by a systematic pelvic lymphadenectomy.Para-aortic lymphadenectomy (PAAL) was recommended for patients with positive SLN at intraoperative examination or final histology and for those with high-risk EC according to the current guidelines | H&E, IHC、ultrastaging |
| Sawicki S | 2015 | 60 | NR | Endometrioid 、Clear cell 、Serous | (Tc-99m and blue) dye or blue dye | cervical and Uterine | Open | Pelvic and para-aortic lymphadenectomy (with SLNB) was performed in patients with grade 3 tumors, with more than 50% myometrial invasion or cervical involvement (in the latter 2 cases, the extent of para-aortic lymph node dissection was at a surgeon’ s discretion). | H&E、ultrastaging |
| Touhami O | 2015 | 39 | Retrospective | Uterine Serous Carcinoma | Tc-99m and patent blue | Uervical | Open or Laparoscopic | Pelvis lymph nodes + para-aortic lymph nodes. | NR |
| P. Valha | 2015 | 18 | Prospective | All | Blue dye | Uterine | Open | Pelvic and para-aortic lymphadenectomies | H&E, IHC、ultrastaging |
| A. Buda | 2016 | 118 | Retrospective | All | Tc-99m and blue dye or blue day or ICG | Cervical | Open or Laparoscopic | Complete pelvic lymphadenectomy and in the absence of SLN mapping or unilateral mapping | H&E, IHC、ultrastaging |
| J. Ehrisman | 2016 | 36 | Retrospective | All | Meth-ylene blue or indocyanine green (ICG) | Cervical | Laparoscopic | Complete pelvic lymphadenectomy | H&E, IHC、ultrastaging |
| R. W. Holloway | 2016 | 119 | Retrospective | All | ICG | Cervical | Robotic | A pelvic lymphadenectomy or pelvic-plus-aortic lymphadenectomy Para-aortic lymphadenectomy was reserved for Grade 3 tumors/Type II histologies with any depth-of-invasion (DOI),grossly positive pelvic lymph nodes confirmed on frozen section,and low-grade tumors with middle or outer-third myometrial invasion. | H&E, IHC、ultrastaging |
| P. J. Paley | 2016 | 85 | Prospective | All | ICG | Cervical | Robotic | Complete pelvic and paraaortic lymphadenectomy if high risk or in the absence of SLN mapping or unilateral mapping | H&E |
| A. Papadia | 2016 | 42 | Retrospective | All | ICG | Cervical | Laparoscopic | PLND and/or PALND | H&E, IHC、ultrastaging |
| G. Baiocchi | 2017 | 75 | Prospective | All | Patent blue dye | Cervical | NR | Pelvic ± para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| I. Biliatis | 2017 | 54 | Prospective | All | Methylene blue or patent blue | Uterine | NR | Bilateral pelvic lymphadenectomy | H&E |
| F. Farzaneh | 2017 | 30 | Prospective | Endometrioid、Papillary serous | Tc-99m or( TC-99m and Blue dye) | Cervical | NR | Pelvic lymphadenectomy in all cases and para-aortic lymphadenectomy in selected cases (clear cell, papillary serous, grade 2 or 3 endometrioid adenocarcinomas, stage II). | NR |
| R. W. Holloway | 2017 | 200 | Prospective | All | ISB + ICG or ISB | Cervical | Robotic | Pelvic lymphadenectomy was performed in all cases. Para-aortic lymphadenectomy procedures were performed for patients with endometrioid G1 or G2 tumors and 50% or more myometrial invasion on frozen section or any G3 and type 2 histologies, and for patients with suspicious pelvic lymph nodes confirmed with metastases on frozen section. | H&E, IHC、ultrastaging |
| E. C. Rossi | 2017 | 340 | Prospective | All | ICG | Cervical | Robotic | Pelvic lymphadenectomy with or without para-aortic lymphadenectomy. | H&E, IHC、ultrastaging |
| P. T. Soliman | 2017 | 101 | Prospective | All | ICG or Blue dye or(TC-99m and Blue dye) | Cervical | Robotic or Laparoscopic | Pelvic and para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| E. J. Tanner | 2017 | 52 | Prospective | All | ISB or ICG | Cervical | Robotic | Pelvic and para-aortic lymph nodes | H&E, IHC、ultrastaging |
| S. Taskin | 2017 | 71 | Prospective | All | ICG | Cervical | Laparoscopic | Complete pelvic lymphadenectomy,paraaortic lymphadenectomy if high risk | H&E, IHC、ultrastaging |
| O. Touhami | 2017 | 128 | Retrospective | All | Blue dye、Technetium-99、Indocyanine green、Blue dye + technetium-99、Indocyanine green + technetium-99 | Cervical | Laparoscopic or Robotic or Open | Pelvic lymphadenectomy,the indication and extent of the para-aortic lymphadenectomy (PAL) was left at the discretion of the surgeon. | H&E, IHC、ultrastaging |
| N. Body | 2018 | 119 | Retrospective | All | ICG | Cervical | Laparoscopic or Robotic or Open | All patients underwent total hysterectomy and bilateral salpingo-oophorectomy and a complete pelvic lymph node dissection following SLN mapping. Paraaortic node dissection was performed at the surgeon's discretion. | H&E, IHC、ultrastaging |
| K. J. Eoh | 2018 | 50 | NR | All | ICG | Uterine or Cervical | Laparoscopic | Systematic bilateral pelvic lymph node | H&E |
| A. Rajanbabu | 2018 | 69 | Prospective | All | ICG | Cervical | Robotic | Pelvic and paraaortic LND was done based on pre-operative risk factors (endometrial biopsy result and MRI staging). | H&E |
| C. Shimada | 2018 | 57 | Retrospective | All | TC-99m or/and ICG | Cervical | Laparoscopic or Open | Lymphadenectomy, the extent of lymphadenectomy was at the discretion of the attending surgeon. | H&E, IHC、ultrastaging |
| Tanaka T | 2018 | 211 | NR | All | TC-99m or IDG or ICG | Cervical | Laparoscopic or Open | All of the patients underwent laparoscopic or abdominal hysterectomy, bilateral salpingo-oophorectomy and an SLN biopsy with or without PLND and paraaortic lymph node dissection (PAND). | H&E |
| S. Togami | 2018 | 113 | Prospective | All | ICG | Cervical or Uterine | Laparoscopic or Robotic or Open | Complete pelvic lymphadenectomy,paraaortic lymphadenectomy if high risk | H&E |
| F. J. Backes | 2019 | 184 | Prospective | All | ISB and ICG | Cervical | Robotic | SLN biopsy was followed by complete pelvic lymphadenectomy (aortic lymphadenectomy at the discretion of the surgeon). | H&E, IHC、ultrastaging |
| J. A. Kennard | 2019 | 414 | Retrospective | All | ISB and ICG | Cervical | Robotic | Completion pelvic lymphadenectomy was performed in all patients during this time of this study for quality assurance to determine false negative rates (FNR) for surgeons in the group. | H&E, IHC、ultrastaging |
| J. Persson | 2019 | 257 | Prospective | All | ICG | Cervical | Robotic | Pelvic and infrarenal para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| S. Taşkin | 2019 | 286 | Retrospective | All | ICG or blue dye | Cervical | Laparoscopic or Robotic or Open | Pelvic ± para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| T. Wang | 2019 | 98 | Retrospective | All | ICG | Cervical | Laparoscopic | Pelvic ± para-aortic lymphadenectomy | H&E, IHC、ultrastaging |
| L. Ye | 2019 | 131 | Prospective | All | ICG | Cervical | Laparoscopic | Complete bilateral lymphadenectomy was then performed in all patients. Patients with high-risk histologies(grade 3 endometrioid, carcinosarcoma, serous, clear cell, or undifferentiated carcinoma) underwent simultaneous paraaortic lymphadenectomy to the inferior mesenteric artery and lymentectomy. | H&E, IHC、ultrastaging |
| J. Zuo | 2019 | 115 | Prospective | Endometrioid | Carbon nanoparticle | Cervical or Uterine | Laparoscopic | Para-aortic lymph node sampling procedures were performed for low-risk patient (Based on the MRI result: primary tumor is less than 2 cm in diameter, less than 50% myometrial invasion, and the pathology is non-poorly differentiated carcinoma), while the para-aortic lymphadenectomy was performed for non-low risk patient. | H&E, IHC、ultrastaging |
| Ş. Gezer | 2020 | 81 | Prospective | All | TC-99m | Cervical or Uterine | Open | Pelvic and paraaortic lymphadenectomy procedures | H&E, IHC、ultrastaging |
| F. Martinelli | 2020 | 208 | Retrospective | All | ICG or TC-99m | Uterine | Laparoscopic | Lymphadenectomy (pelvic ± aortic) | H&E, IHC、ultrastaging |
| M. Renz | 2020 | 90 | Retrospective | All | ICG | Cervical | NR | Complete pelvic lymphadenectomy,paraaortic lymphadenectomy if high risk | H&E |
| V. S | 2020 | 35 | Prospective | All | TC-99m | Cervical | Open | Complete pelvic and lower para-aortic lymphadenectomy | H&E |
| M. A. Angeles | 2021 | 102 | Prospective | All | TC-99m | Uterine | Laparoscopic | Systematic pelvic and paraaortic lymphadenectomy | H&E, IHC、ultrastaging |
| E. Curcio | 2021 | 44 | Retrospective | All | ICG | Cervical | Robotic | Systematic pelvic LND was performed in case of negative bilateral mapping, and for tumors >2 cm in greatest dimension or invading >50% of the myometrium. Pelvic and paraaortic LND up to the level of the renal veins was attempted for all grade 3 tumors, uterine serous cancer, clear cell carcinoma,and carcinosarcoma. | H&E, IHC、ultrastaging |
| M. C. Cusimano | 2021 | 156 | Prospective | All | ICG | Cervical | Laparoscopic or Robotic | Grade 2 endometrioid EC required bilateral PLND,and high-grade EC required bilateral PLND and PALND | H&E, IHC、ultrastaging |
| S. Liang | 2021 | 90 | Prospective | All | ICG or CNPs or ICG + CNPs | Cervical | Laparoscopic or Open | Systemic pelvic lymphadenectomy was performed. Para‐aortic lymphadenectomy was performed at the surgeon's discretion | H&E |
| V. G. Pineda | 2021 | 88 | Retrospective | All | ICG+Tc99 or Tc99+Blue dye or ICG | Cervical | Laparoscopic | Complete pelvic and paraaortic lymphadenectomy | H&E, IHC、ultrastaging |
| N. Sánchez-Izquierdo | 2021 | 52 | Retrospective | All | ICG and TC-99m | Uterine | Laparoscopic | Pelvic and paraaortic lymphadenectomy | H&E, IHC、ultrastaging |
| S. Somashekhar | 2021 | 100 | Prospective | All | ICG | Cervical | Robotic | Complete pelvic and para-aortic node dissection | ultrastaging |
| Q. Wang | 2021 | 92 | Retrospective | All | ICG | (Cervical and Uterine)or Cervial | Laparoscopic | Pelvic lymphadenectomy with or without infrarenal para‐aortic lymphadenectomy | H&E, IHC、ultrastaging |
| D. Altin | 2022 | 128 | Retrospective | All | MB or ICG | Cervical | Laparoscopic or Open or Robotic | Pelvic ± paraaortic lymphadenectomy | H&E, IHC、ultrastaging |
| M. Gedgaudaite | 2022 | 90 | Prospective | All | ICG | Cervical | Laparoscopic | LND | NR |
| A. Torrent | 2022 | 48 | Prospective | All | ICG and TC-99m | (Cervical and Uterine)or Cervial | NR | Pelvic ± paraaortic lymphadenectomy | H&E, IHC、ultrastaging |
| Y. Xue | 2022 | 159 | Retrospective | All | ICG | Cervical | Laparoscopic | Systematic lymphadenectomy | H&E, IHC、ultrastaging |
H&E, Hematoxylin and eosin; IHC, Immunohistochemistry; LND, Lymphadenectomy; NR, Not reported; SLN, Sentinel lymph node; Tc-99m, Technecium-99; ICG, Indocyanine green; ISB, Isosulfane blue; MB, Methylene blue; CNP, Carbon nanoparticle.