Daniel Skubleny1, Jerry T Dang2, Samuel Skulsky3, Noah Switzer2, Chunhong Tian2, Xinzhe Shi4, Christopher de Gara2,4, Daniel W Birch2,4, Shahzeer Karmali2,4. 1. Department of Surgery, Faculty of Medicine and Dentistry, 2D, Walter C Mackenzie Health Sciences Centre, University of Alberta, 840-112 Street, Edmonton, T6G 2B7, Canada. skubleny@ualberta.ca. 2. Department of Surgery, Faculty of Medicine and Dentistry, 2D, Walter C Mackenzie Health Sciences Centre, University of Alberta, 840-112 Street, Edmonton, T6G 2B7, Canada. 3. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 4. Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada.
Abstract
BACKGROUND: Sentinel node navigation surgery (SNNS) for gastric cancer using infrared visualization of indocyanine green (ICG) is intriguing because it may limit operative morbidity. We are the first to systematically review and perform meta-analysis on the diagnostic utility of ICG and infrared electronic endoscopy (IREE) or near infrared fluorescent imaging (NIFI) for SNNS exclusively in gastric cancer. METHODS: A search of electronic databases MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms "gastric/stomach" AND "tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy" AND "indocyanine green" was completed in May 2017. Articles were selected by two independent reviewers based on the following major inclusion criteria: (1) diagnostic accuracy study design; (2) indocyanine green was injected at tumor site; (3) IREE or NIFI was used for intraoperative visualization. 327 titles or abstracts were screened. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS: Ten full text studies were selected. 643 patients were identified with the majority of patients possessing T1 tumors (79.8%). Pooled identification rate, diagnostic odds ratio, sensitivity, and specificity were 0.99 (0.97-1.0), 380.0 (68.71-2101), 0.87 (0.80-0.93), and 1.00 (0.99-1.00), respectively. The summary receiver operator characteristic for ICG + IREE/NIFI demonstrated a test accuracy of 98.3%. Subgroup analysis found improved test performance for studies with low-risk QUADAS-2 scores, studies published after 2010 and submucosal ICG injection. IREE had improved diagnostic odds ratio, sensitivity, and identification rate compared to NIFI. Heterogeneity among studies ranged from low (I2 < 25%) to high (I2 > 75%). CONCLUSIONS: We found encouraging results regarding the accuracy, diagnostic odds ratio, and specificity of the test. The sensitivity was not optimal but may be improved by a strict protocol to augment the technique. Given the number and heterogeneity of studies, our results must be viewed with caution.
BACKGROUND: Sentinel node navigation surgery (SNNS) for gastric cancer using infrared visualization of indocyanine green (ICG) is intriguing because it may limit operative morbidity. We are the first to systematically review and perform meta-analysis on the diagnostic utility of ICG and infrared electronic endoscopy (IREE) or near infrared fluorescent imaging (NIFI) for SNNS exclusively in gastric cancer. METHODS: A search of electronic databases MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms "gastric/stomach" AND "tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy" AND "indocyanine green" was completed in May 2017. Articles were selected by two independent reviewers based on the following major inclusion criteria: (1) diagnostic accuracy study design; (2) indocyanine green was injected at tumor site; (3) IREE or NIFI was used for intraoperative visualization. 327 titles or abstracts were screened. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS: Ten full text studies were selected. 643 patients were identified with the majority of patients possessing T1 tumors (79.8%). Pooled identification rate, diagnostic odds ratio, sensitivity, and specificity were 0.99 (0.97-1.0), 380.0 (68.71-2101), 0.87 (0.80-0.93), and 1.00 (0.99-1.00), respectively. The summary receiver operator characteristic for ICG + IREE/NIFI demonstrated a test accuracy of 98.3%. Subgroup analysis found improved test performance for studies with low-risk QUADAS-2 scores, studies published after 2010 and submucosal ICG injection. IREE had improved diagnostic odds ratio, sensitivity, and identification rate compared to NIFI. Heterogeneity among studies ranged from low (I2 < 25%) to high (I2 > 75%). CONCLUSIONS: We found encouraging results regarding the accuracy, diagnostic odds ratio, and specificity of the test. The sensitivity was not optimal but may be improved by a strict protocol to augment the technique. Given the number and heterogeneity of studies, our results must be viewed with caution.
Authors: Afina S Glas; Jeroen G Lijmer; Martin H Prins; Gouke J Bonsel; Patrick M M Bossuyt Journal: J Clin Epidemiol Date: 2003-11 Impact factor: 6.437
Authors: Quirijn R J G Tummers; Leonora S F Boogerd; Wobbe O de Steur; Floris P R Verbeek; Martin C Boonstra; Henricus J M Handgraaf; John V Frangioni; Cornelis J H van de Velde; Henk H Hartgrink; Alexander L Vahrmeijer Journal: World J Gastroenterol Date: 2016-04-07 Impact factor: 5.742
Authors: Sepideh Gholami; Lucas Janson; David J Worhunsky; Thuy B Tran; Malcolm Hart Squires; Linda X Jin; Gaya Spolverato; Konstantinos I Votanopoulos; Carl Schmidt; Sharon M Weber; Mark Bloomston; Clifford S Cho; Edward A Levine; Ryan C Fields; Timothy M Pawlik; Shishir K Maithel; Bradley Efron; Jeffrey A Norton; George A Poultsides Journal: J Am Coll Surg Date: 2015-05-05 Impact factor: 6.113
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396
Authors: Dolores Müller; Raphael Stier; Jennifer Straatman; Benjamin Babic; Lars Schiffmann; Jennifer Eckhoff; Thomas Schmidt; Christiane Bruns; Hans F Fuchs Journal: Chirurgie (Heidelb) Date: 2022-06-03
Authors: Francesco Belia; Alberto Biondi; Annamaria Agnes; Pietro Santocchi; Antonio Laurino; Laura Lorenzon; Roberto Pezzuto; Flavio Tirelli; Lorenzo Ferri; Domenico D'Ugo; Roberto Persiani Journal: Front Surg Date: 2022-06-28
Authors: Fernando Dip; Luigi Boni; Michael Bouvet; Thomas Carus; Michele Diana; Jorge Falco; Geoffrey C Gurtner; Takeaki Ishizawa; Norihiro Kokudo; Emanuele Lo Menzo; Philip S Low; Jaume Masia; Derek Muehrcke; Francis A Papay; Carlo Pulitano; Sylke Schneider-Koraith; Danny Sherwinter; Giuseppe Spinoglio; Laurents Stassen; Yasuteru Urano; Alexander Vahrmeijer; Eric Vibert; Jason Warram; Steven D Wexner; Kevin White; Raul J Rosenthal Journal: Ann Surg Date: 2022-04-01 Impact factor: 13.787