Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1883-1893
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1883
Application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy diagnosis of gastric cancer: Meta-analysis
Qi-Jia Zhang, Zhi-Cheng Cao, Qin Zhu, Yu Sun, Rong-Da Li, Jin-Long Tong, Qin Zheng
Qi-Jia Zhang, Zhi-Cheng Cao, Qin Zhu, Yu Sun, Jin-Long Tong, Qin Zheng, Department of Oncology, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
Rong-Da Li, Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan 250063, Shandong Province, China
Co-corresponding authors: Jin-Long Tong and Qin Zheng.
Author contributions: Zhang QJ wrote the manuscript; Cao ZC, Zhu Q, Sun Y and Li RD collected the data; Tong JL and Zheng Q guided the study. Both Tong JL and Zheng Q have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Tong JL applied for and obtained the funds for this research project. Tong JL conceptualized, designed, and supervised the whole process of the project. He searched the literature, revised and submitted the early version of the manuscript. Zheng Q was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation and submission of the current version of the manuscript. This collaboration between Tong JL and Zheng Q is crucial for the publication of this manuscript and other manuscripts still in preparation. All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qin Zheng, PhD, Doctor, Department of Oncology, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, No. 1-1 Zhongfu Road, Gulou District, Nanjing 210003, Jiangsu Province, China. njyy040@njucm.edu.cn
Received: March 5, 2024
Revised: May 12, 2024
Accepted: May 24, 2024
Published online: June 27, 2024
Processing time: 116 Days and 15.8 Hours
Abstract
BACKGROUND

Gastric cancer is a common malignant tumor of the digestive system worldwide, and its early diagnosis is crucial to improve the survival rate of patients. Indocyanine green fluorescence imaging (ICG-FI), as a new imaging technology, has shown potential application prospects in oncology surgery. The meta-analysis to study the application value of ICG-FI in the diagnosis of gastric cancer sentinel lymph node biopsy is helpful to comprehensively evaluate the clinical effect of this technology and provide more reliable guidance for clinical practice.

AIM

To assess the diagnostic efficacy of optical imaging in conjunction with indocyanine green (ICG)-guided sentinel lymph node (SLN) biopsy for gastric cancer.

METHODS

Electronic databases such as PubMed, Embase, Medline, Web of Science, and the Cochrane Library were searched for prospective diagnostic tests of optical imaging combined with ICG-guided SLN biopsy. Stata 12.0 software was used for analysis by combining the "bivariable mixed effect model" with the "midas" command. The true positive value, false positive value, false negative value, true negative value, and other information from the included literature were extracted. A literature quality assessment map was drawn to describe the overall quality of the included literature. A forest plot was used for heterogeneity analysis, and P < 0.01 was considered to indicate statistical significance. A funnel plot was used to assess publication bias, and P < 0.1 was considered to indicate statistical significance. The summary receiver operating characteristic (SROC) curve was used to calculate the area under the curve (AUC) to determine the diagnostic accuracy. If there was interstudy heterogeneity (I2 > 50%), meta-regression analysis and subgroup analysis were performed.

RESULTS

Optical imaging involves two methods: Near-infrared (NIR) imaging and fluorescence imaging. A combination of optical imaging and ICG-guided SLN biopsy was useful for diagnosis. The positive likelihood ratio was 30.39 (95%CI: 0.92-1.00), the sensitivity was 0.95 (95%CI: 0.82-0.99), and the specificity was 1.00 (95%CI: 0.92-1.00). The negative likelihood ratio was 0.05 (95%CI: 0.01-0.20), the diagnostic odds ratio was 225.54 (95%CI: 88.81-572.77), and the SROC AUC was 1.00 (95%CI: The crucial values were sensitivity = 0.95 (95%CI: 0.82-0.99) and specificity = 1.00 (95%CI: 0.92-1.00). The Deeks method revealed that the "diagnostic odds ratio" funnel plot of SLN biopsy for gastric cancer was significantly asymmetrical (P = 0.01), suggesting significant publication bias. Further meta-subgroup analysis revealed that, compared with fluorescence imaging, NIR imaging had greater sensitivity (0.98 vs 0.73). Compared with optical imaging immediately after ICG injection, optical imaging after 20 minutes obtained greater sensitivity (0.98 vs 0.70). Compared with that of patients with an average SLN detection number < 4, the sensitivity of patients with a SLN detection number ≥ 4 was greater (0.96 vs 0.68). Compared with hematoxylin-eosin (HE) staining, immunohistochemical (+ HE) staining showed greater sensitivity (0.99 vs 0.84). Compared with subserous injection of ICG, submucosal injection achieved greater sensitivity (0.98 vs 0.40). Compared with 5 g/L ICG, 0.5 and 0.05 g/L ICG had greater sensitivity (0.98 vs 0.83), and cT1 stage had greater sensitivity (0.96 vs 0.72) than cT2 to cT3 clinical stage. Compared with that of patients ≤ 26, the sensitivity of patients > 26 was greater (0.96 vs 0.65). Compared with the literature published before 2010, the sensitivity of the literature published after 2010 was greater (0.97 vs 0.81), and the differences were statistically significant (all P < 0.05).

CONCLUSION

For the diagnosis of stomach cancer, optical imaging in conjunction with ICG-guided SLN biopsy is a therapeutically viable approach, especially for early gastric cancer. The concentration of ICG used in the SLN biopsy of gastric cancer may be too high. Moreover, NIR imaging is better than fluorescence imaging and may obtain higher sensitivity.

Keywords: Gastric neoplasms, Sentinel lymph nodes, Near infrared imaging, Fluorescence imaging, Indocyanine green, Meta-analysis

Core Tip: To explore Indocyanine green fluorescence imaging (ICG-FI) in guiding the diagnosis of gastric cancer sentinel lymph node biopsy through meta-analysis. We will collect and analyze relevant literature to systematically evaluate the clinical manifestations of ICG-FI in gastric cancer patients and compare its diagnostic effectiveness with that of traditional methods. This study will provide clinicians with a more accurate intraoperative evaluation method for gastric cancer, which will help guide surgical decision making and improve patient prognosis.