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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 8  |  Page : 256-259

The predictive value of cervical lymph node metastasis through sentinel lymph node biopsy in patients with oral cancer: A meta-analysis


Department of Stomatology, The People's Hospital of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China

Date of Web Publication22-Feb-2017

Correspondence Address:
Liujun Tang
Department of Stomatology, The People's Hospital of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200751

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 > Abstract 

Objective: The purpose of this meta-analysis was to evaluate the predictive value of cervical lymph node metastasis through sentinel lymph node biopsy (SLNB) in patients with oral cancer.
Materials and Methods: Two authors independently searched the databases of PubMed, Cochrane central register of controlled trials, EMBASE, and CNKI to find the potential suitable diagnostic study related to SLNB. The diagnostic sensitivity, specificity, positive likely hood ratio (+LR), negative likely hood ratio (–LR), diagnostic odds ratio (DOR) were pooled by Meta-DiSc1.4 software. The publication bias was assessed by funnel plot and line regression test.
Results: After electronic searching the related databases, we finally included twenty diagnostic studies. The pooled sensitivity, specificity, +LR, and DOR were 0.91 (95% confidence interval [CI]: 0.88–0.94), 1.00 (95% CI: 0.99–1.00), 35.52 (95% CI: 19.19–65.75), and 323.50 (95% CI: 148.27–705.83), respectively, with fixed-effect model. Moreover, the pooled –LR was 0.13 (95% CI: 0.07–0.23) by random-effect model. The area under the summary receiver operating characteristic curve of SLNB for cervical lymph node metastasis was 0.99.
Conclusion: SLNB had very high sensitivity and specificity for productizing cervical lymph node metastasis in oral cancer patients.

Keywords: Diagnosis, meta-analysis, oral cancer, sentinel lymph node biopsy


How to cite this article:
Lin R, Yan J, Liu W, Fan T, Tang L. The predictive value of cervical lymph node metastasis through sentinel lymph node biopsy in patients with oral cancer: A meta-analysis. J Can Res Ther 2016;12:256-9

How to cite this URL:
Lin R, Yan J, Liu W, Fan T, Tang L. The predictive value of cervical lymph node metastasis through sentinel lymph node biopsy in patients with oral cancer: A meta-analysis. J Can Res Ther [serial online] 2016 [cited 2017 Mar 26];12:256-9. Available from: http://www.cancerjournal.net/text.asp?2016/12/8/256/200751


 > Introduction Top


Oral cancer is a kind of malignant carcinomas arising from any of the tissues in the mouth. There are several types of oral cancers, but around 90% are squamous cell carcinomas, originating in the tissues of mouth or lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). The treatment principle is surgery plus postoperative chemoradiotherapy. The cervical lymph node status is important for treatment method selection and prognosis. The prediction of cervical lymph node metastasis through sentinel lymph node biopsy (SLNB) is generally used in patients with oral cancer. In this study, we use meta-analysis method to further evaluate the predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer.


 > Materials and Methods Top


Publication searching

The electronic searching was performed according to <<The Bayes Library of Diagnostic Studies and Reviews>>. The searching words were “cancer of oral/oral cancer; sentinel lymph node biopsy; SLNB.” The searching databases were PubMed, Cochrane central register of controlled trials, EMBASE, and CNKI.

Inclusion criteria

  1. Study type: A Prospective diagnostic study
  2. Patients included in the study: Patients were diagnosed with oral cancer
  3. Method: SLNB
  4. Gold diagnosis standard: Pathology confirmation.


Exclusion criteria

  1. Review or case–control study
  2. Duplicate publication data
  3. Incomplete data
  4. Publication not in English or Chinese.


Data extraction

Tonghai Fan and Liujun Tang independently extracted author name, publication year, country, number of true positive, false positive, false negative, and true negative.

Statistical method

The statistical heterogeneity was tested by I2. If I2 <50%, the data were pooled by fixed-effect model; otherwise, by random-effect model.[1] The diagnostic sensitivity, specificity, positive likely hood ratio (+LR), negative likely hood ratio (–LR), diagnostic odds ratio (DOR) were pooled by Meta-DiSc1.4 software (http://www.biomedsearch.com). P < 0.05 was statistically significant.


 > Results Top


Publication searching

One hundred and eleven diagnostic studies were found after searching the databases. Further reading the title and abstract, sixty publications were excluded from the analysis. Moreover, after reading the full-text paper, 31 papers were excluded, and finally, twenty studies were included in this meta-analysis. The detail information for included papers is showed in [Table 1].
Table 1: The characteristics of included publications

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Heterogeneity

Statistical heterogeneity was assessed by I2 test. There was no significant statistical heterogeneity in sensitivity (I2 = 44.6%), specificity (I2 = 0.0%), +LR (I2 = 0.0%), and DOR (I2 = 0.0%). However, for –LR, there was significant heterogeneity across the included studies (I2 = 66.9%). Thereafter, the data were pooled by fixed-effect model in sensitivity, specificity, +LR, and DOR but by random-effect model in –LR.

Pooled sensitivity and specificity

The pooled sensitivity, specificity, +LR, and DOR were 0.91 (95% confidence interval [CI]: 0.88–0.94), 1.00 (95% CI: 0.99–1.00), 35.52 (95% CI: 19.19–65.75), and 323.50 (95% CI: 148.27–705.83), respectively with fixed-effect model. Moreover, the pooled –LR was 0.13 (95% CI: 0.07–0.23) by random-effect model [Table 2].
Table 2: Quality assessment

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Area under the receiver operating characteristic

The area under the summary receiver operating characteristic curve (AUC) of SLNB for cervical lymph node metastasis was 0.99 [Figure 1].
Figure 1: Receiver operating characteristic curve of the diagnostic value of sentinel lymph node biopsy for cervical lymph node metastasis

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Publication bias

The publication bias was assessed by funnel plot and line regression test. The funnel plot was a little left and right asymmetry which indicated potential publication bias. However, the line regression test demonstrated no significant publication bias (t = –1.87, P > 0.05) [Figure 2].
Figure 2: The funnel plot for evaluation publication bias

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 > Discussion Top


Sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. Moreover, it is important for the advent of the SLNB technique which can provide important information for cancer treatment process selection. SLNB in patients with oral cancer was generally applied in operation, which can provide information for discrimination cervical lymph node metastasis or not. Cervical lymph node status is important for operation method and prognosis. Previously, studies have discussed the clinical predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer.[11],[12],[13],[14] However, the number of patients included in each study was relatively small, and the statistical power is relative low. Hence, the clinical evidence for predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer was not strong enough. Thereafter, we use meta-analysis method to pool the open published studies related to SLNB in patients with oral cancer. After searching the databases, we finally included twenty publications in this meta-analysis. The pooled sensitivity, specificity, +LR, and DOR were 0.91 (95% CI: 0.88–0.94), 1.00 (95% CI: 0.99–1.00), 35.52 (95% CI: 19.19–65.75), and 323.50 (95% CI: 148.27–705.83), respectively, with fixed-effect model. Moreover, the pooled –LR was 0.13 (95% CI: 0.07–0.23) by random-effect model. Moreover, the AUC of SLNB for cervical lymph node metastasis was 0.99. The pooled data indicated that the diagnostic sensitivity and specificity were very high for productizing cervical lymph node metastasis in oral cancer patients. However, some other scientists consider that some metastasis may occur in the neck soft tissue or cervical lymph node before sentinel lymph node metastasis. Then, the status of sentinel lymph node cannot reflect the status of cervical lymph node. Therefore, the predictive value of cervical lymph node metastasis through SLNB in patients with oral cancer should be further evaluated by well-designed, prospective diagnosis study.[21]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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Rigual N, Douglas W, Lamonica D, Wiseman S, Cheney R, Hicks W Jr., et al. Sentinel lymph node biopsy: A rational approach for staging T2N0 oral cancer. Laryngoscope 2005;115:2217-20.  Back to cited text no. 14
    
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Pastore A, Turetta GD, Tarabini A, Turetta D, Feggi L, Pelucchi S. Sentinel lymph node analysis in squamous carcinoma of the oral cavity and oropharynx. Tumori 2002;88:S58-60.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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