Table 1.
Characteristics of studies in the meta-analysis
| Authors | Year | Origin | Technique | Cases (N) | Surgical method | Tracer | Mode | SN definition | True + | True − | False − | Prevalence |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| O’Boyle [6] | 2000 | USA | Serial section, no description | 20 | LAR | Isosulfan blue dye | 4 ml, 4 quadrants | Obvious blue nodes | 3 | 8 | 1 | 4/12 |
| Malur [7] | 2001 | Germany | H&E | 50 | LAP(45), LAR(5) | Patent blue(9), 99mmtc both(20) | NR, 50 MBq in 1 ml(21) | Audible signals; blue-stained lymph node | 5 | 33 | 1 | 6/39 |
| Lantzsch [13] | 2001 | Austria | Serial section, H&E, IHC SLN only | 14 | LAR | 99mmtc colloid | 1 depot, 60–111 MBq | Radioactive nodes | 1 | 12 | 0 | 1/13 |
| Rhim [14] | 2002 | Korea | 3 sections, H&E | 26 | LAR | 99mmtc colloid, blue dye | 2–3 depot, 10–20 MBq | Blue-stained node; radioactive nodes | 4 | 20 | 1 | 5/25 |
| Levenback [15] | 2002 | USA | Serial sectioning, H&E, IHC Only on SN | 39 | LAR | Isosulfan blue dye, Tc99m | 4 ml 4 quadrant, 1–1.5 ml | Sentinel nodes labeled as blue, hot(radioactive), or both | 7 | 25 | 1 | 8/33 |
| Lambaudie [16] | 2003 | France | Frozen section, IHC only on SLN | 12 | LAP | Patent blue, 99mmtc colloid | 4 ml 4 quadrant, 74 MBq | Blue and/or radioactive sentinel node | 2 | 9 | 0 | 2/11 |
| Dargent [17] | 2003 | France | Serial sections, IHC | 70 | LAR | Blue dye, Tc99m | 2 ml, 1 mCi | Blue-stained/radioactive lymph node | 9 | 110 | 10 | 19/129 |
| Van Dam [18] | 2003 | Belgium | 5-mm, sections, H&E, IHC only on SN | 25 | 2 LAP23 LAR | Tc99m | 2 quadrant, 60 MBq | Radioactive nodes | 5 | 16 | 0 | 5/21 |
| Hubalewska [19] | 2003 | Poland | H&E, IHC only on SN | 37 | LAR | Patent blue dye, Tc99m | 4 ml, 4 quadrant, 100 MBq | Radioactive nodes, blue-stained nodes | 5 | 30 | 0 | 5/35 |
| Niikura [20] | 2004 | Japan | H&E, IHC on all nodes | 20 | LAR | Patent blue dye, 99m Tc | 4 ml 4 quadrant,38–70 MBq | Radioactive and blue nodes | 2 | 16 | 0 | 2/18 |
| Lin Bin [21] | 2004 | China | Pathological examination | 28 | LAR | Tc99m | 37 MBq | Radioactive nodes | 6 | 21 | 0 | 6/21 |
| Martı´nez-Palones [22] | 2004 | Spain | 0.2-mm interval, H&E, IHC only on SN | 25 | 7LAP, 18 LAR | Blue dye, Tc99m | 2–4 ml, 20 MBq | Blue-stained nodes | 3 | 19 | 0 | 3/23 |
| Pijpers [23] | 2004 | The Netherlands | Frozen section, 250-μm intervals H&E, IHC only on SN | 34 | LAP | Patent blue dye, Tc99m | 2–4 ml, 4 quadrant, 228 MBq | Blue as well as radioactive nodes | 11 | 21 | 1 | 12/33 |
| Marchiole [24] | 2004 | France | Frozen sectioning, 200-μm intervals, H&E, IHC on all nodes | 29 | LAP | Patent blue dye | 4 ml, 4 quadrant | Unknown | 5 | 21 | 3 | 8/29 |
| Di Stefano [25] | 2005 | Italy | 200-μm serial sections, H&E, IHC only on SN | 50 | LAR | Methylene blue dye | 2 ml, 4 quadrant | Blue-stained lymph nodes | 9 | 35 | 1 | 10/45 |
| Gil-Moreno [26] | 2005 | Spain | 0.2 mm sections, H&E, IHC only on SN | 12 | LAP | 99mmtc colloid, blue dye | 2–4 ml 4 quadrant, 40 MBq | Blue, hot lymph nodes | 0 | 12 | 0 | 0/12 |
| Rob [27] | 2005 | Czech Republic | Frozen section, 40-μm intervals, H&E, IHC only on SN | 183 | 39 LAP,144 LAR | Patent blue dye, Tc99m | 2 ml 4 quadrant, 20 MBq | Blue nodes, radioactive nodes | 35 | 124 | 1 | 36/160 |
| Angioli [28] | 2005 | Italy | Serial sectioning, H&E, IHC only on SN | 33 | LAP | Tc99m colloid | 4 quadrant, 60 MBq | Radioactive nodes | 6 | 20 | 0 | 6/26 |
| Roca [29] | 2005 | Spain | 0.2 mm sections, H&E, IHC on all nodes | 40 | 12 LAP 28 LAR | Blue dye, Tc99m | 2–4 ml 4 quadrant, 74 MBq | Blue-stained nodes | 4 | 36 | 0 | 4/36 |
| Sliva [30] | 2005 | Brazil | 2–3 mm intervals H&E, IHC only on SN | 56 | LAR | Tc99m | 4 quadrant, 55–74 MBq | Radioactive nodes | 17 | 32 | 3 | 20/52 |
| Lin [31] | 2005 | Taiwan | 250-μm intervals H&E, IHC only on SN | 30 | LAR | 99mmtc colloid | 4 quadrant, 202 MBq | Radioactive nodes | 7 | 23 | 0 | 7/30 |
| Wydar [32] | 2006 | Poland | 250-μm intervals H&E, IHC only on SN | 100 | LAR | 99mmtc, blue dye | 1 ml, 4 quadrant, 35–70 MBq, 4 ml | Radioactive nodes; blue-stained nodes | 19 | 63 | 3 | 22/85 |
| Wang [33] | 2006 | China | H&E, IHC RT-PCR | 46 | LAP | Methylene blue | 2 ml | Blue-stained lymph nodes | 28 | 18 | 0 | 28/46 |
| Altgassen [34] | 2007 | Germany | Frozen | 60 | LAR | Paten blue | 4 ml, 4 quarant, 2 ml with 8 ml NaCl | Blue-stained nodes | 11 | 41 | 4 | 15/56 |
| Bats [35] | 2007 | France | 250-μm intervals H&E, IHC on all nodes | 25 | LAP | Tc99m, patent blue | 4 quadrants, 120 MBq, 2 ml | Blue/radioactive nodes | 2 | 21 | 0 | 2/23 |
| Kushner [36] | 2007 | USA | Frozen section, H&E, IHC only on negative nodes | 20 | LAP | Tc99m, blue dye | 1 ml, 4 quadrants, 4 ml | Radioactive nodes, blue-stained nodes | 2 | 18 | 0 | 2/20 |
| Darai [37] | 2007 | France | 3 mm interval, H&E, IHC only on SN | 54 | LAP | Tc99m | 4 quadrant, 20 MBq | Blue-stained or hot nodes | 11 | 28 | 6 | 17/45 |
| Yong Seok Lee [38] | 2007 | Korea | Frozen biopsy, H&E | 57 | LAR | Isosulfan blue And Tc99m | 1.0 ml, 10–20 MBq | Blue and/or “hot” nodes | 10 | 46 | 1 | 11/57 |
| Seok Ju Seong [39] | 2007 | Korea | Frozen section, H&E staining | 89 | LAR | Isosulfan blue dye | 1 ml | Blue-stained nodes | 10 | 40 | 1 | 11/51 |
| Song-Hua Yuan [40] | 2007 | China | H&E, IHC only on SN | 81 | LAR | Methylene blue dye, patent Blue | 2–4 ml, 4 ml | Blue-stained nodes | 10 | 51/3 | 3 | 13/64 |
| Bats [41] | 2008 | France | 3 mm interval 150-μm, H&E, IHC only on SN | 71 | LAP | Tc99m; patent blue | 0.2 ml, 80 MBq, 4 quadrants | Blue and/or radioactive nodes | 16 | 42 | 2 | 18/60 |
| Fader [42] | 2008 | USA | Imprint cytology and frozen section; H&E, IHC | 38 | 11 LAP, 27 LAR | Tc99m, isosulfan blue | 0.5 mCi, 4 quadrants, 1.5 ml | Radioactive nodes, blue-stained nodes | 5 | 29 | 1 | 6/35 |
| Kara [43] | 2008 | Turkey | H&E, IHC | 32 | LAP | Tc99m, blue dye | 4 quadrants, 74 MBq, 4 ml | Radioactive nodes, blue-stained nodes | 9 | 23 | 0 | 9/32 |
| Pluta [44] | 2009 | Czech Republic | Frozen section, H&E, IHC | 60 | LAR | Patent blue dye, Tc99m | 20 MBq, 4 ml | Blue-colored/radioactive nodes | 5 | 55 | 0 | 5/60 |
| Vieira [45] | 2009 | Brazil | Frozen section, H&E on all nodes | 56 | LAR | Tc99m patent blue dye | 600–800 μCi, 4 quadrants, 4 ml | Stained (blue), ‘‘hot’’ (radioactive) or both | 5 | 41 | 1 | 6/47 |
| Gortzak-Uzan [46] | 2010 | Canada | Frozen sections, H&E, IHC only on SN | 87 | LAP | Tc99m and/or blue dye | 0.1–0.2 μCi, 4 quadrants, 4 ml | Blue/hot lymph nodes | 14 | 67 | 0 | 14/81 |
| Darlin [47] | 2010 | Sweden | Frozen section, H&E | 105 | 91 robot-assisted LAP,8 LAP, 6 LAR | Tc99m | 1–1.5 ml, 120 MBq, 4 quadrants | Radioactive nodes | 17 | 76 | 1 | 18/94 |
| Ogawa [48] | 2010 | Japan | H&E | 82 | LAP | Tc99m | 4 quadrants, 148 MBq | Radioactive hot nodes | 12 | 60 | 0 | 12/72 |
| FOTIOU [49] | 2010 | Greece | standard and enhanced pathological analysis | 42 | LAR | Tc99m, blue dye | 0.8 ml, 4 quadrants, 2 ml | Radioactive nodes; blue-stained nodes | 4 | 33/1 | 1 | 5/38 |
| Cormier [50] | 2011 | US | Frozen section, H&E,IHC | 122 | 37 LAP or robotic-assisted LAP, 85 LAR | Blue dye, Tc99m | 4 ml, unknown | Blue/hot nodes | 21 | 90 | 3 | 24/90 |
| Diaz-Feijoo [51] | 2011 | Spain | H&E, IHC only on negative SLN | 22 | 20 LAP,2 LAR | Tc99m, blue dye | 4 quadrants, 144 MBq, less than 1 ml | Nodes as radioactive, blue positive or both blue and hot | 4 | 18 | 0 | 4/22 |
| Lecuru [52] | 2011 | France | 200-μm section, H&E, IHC only on negative nodes | 139 | LAP | Tc99m, patent blue | 4 quadrants, 120 MBq, 2 ml | Blue-stained and/or radioactive lymph nodes | 23 | 111 | 2 | 25/136 |
| Roy [53] | 2011 | Canada | Serial section, H&E, IHC only on SN | 211 | LAP | Blue dye, Tc99m | 1 ml, 37 MBq | Blue and/or hot nodes | 29 | 177 | 3 | 32/209 |
| Xue-lian Du [54] | 2011 | China | Frozen section, IHC on all nodes | 68 | LAP | Tc99m | 2.5 ml, 4 quadrants, 100 MBq | Radioactive hot nodes | 8 | 56 | 0 | 8/64 |
| Niikura [55] | 2012 | Japan | Frozen section, H&E, IHC | 35 | LAP | Tc99m, blue dye | 0.4 ml, 60 MBq, 4 quadrants, 4 ml | Radioactive and blue nodes | 8 | 24 | 3 | 11/35 |
| Devaja [56] | 2012 | United Kingdom | H&E, IHC only on positive nodes | 86 | LAP, LAR | Tc99m, methylene blue dye | 4 quadrants, 40 MBq, 4 ml | Blue-stained nodes | 9 | 75 | 0 | 9/86 |
| Frumovitz [57] | 2012 | USA | 250-μm intervals, H&E, IHC | 20 | LAR, LAP, or robotic-assisted LAP | Tc99m, India ink | 2 ml, 4 quadrants, 4 ml | Radioactive/blue nodes | 3 | 12 | 2 | 5/17 |
| Schaafsma [58] | 2012 | The Netherlands | H&E, IHC on SN and suspected nodes | 18 | LAR | Indocyanine green | 1.6 ml, 4 quadrants | Nodes with fluorescent hotspots | 5 | 8 | 1 | 6/14 |
| Hoogendam [59] | 2013 | The Netherlands | Frozen section | 62 | Conventional and robot-assisted LAP | Tc99m, patent blue dye | 220–290 MBq, 4 quadrants, 2–4 ml | Blue-stained/radioactive nodes | 7 | 52 | 3 | 10/62 |
SLN sentinel lymph node, H&E hematoxylin and eosin staining, IHC immunohistochemistry, LAR laparotomy, LAP laparoscopy, NR not reported