Main findings
In this study, we systematically investigated the diagnostic performance
of FSE in SLNB for cervical cancer, based on the available data
over
nearly twenty years. To our knowledge, this is the first systematic
review and meta-analysis on this topic. The sensitivity of FSE in SLNB,
which had been surrounded by controversies,
was
found
to be dissatisfactory in pooled analysis (0.77, 95%CI
0.66–0.85). This data is very
close to that previously reported in breast cancer.54However, a more important finding of this study is that the sectioning
protocol of FSE had great impact on diagnostic accuracy, which also
generated a
high
heterogeneity (I 2=69.73%). Significantly
improved sensitivities (pooled: 0.86, 95%CI: 0.79–0.91) and low
heterogeneity (I 2=0) were observed among the
studies using L-protocol, whereas an even lower sensitivity (0.59,
0.46–0.72) was pooled under E-protocol. This difference was so
remarkable that we expected it would hardly be denied or reversed in
future studies. Thus, our study provides
strong
evidence
supporting
L-protocol as the standard for intraoperative pathological examination
of SLNs.
PLND
shares
the same incision with hysterectomy,
lowering
the priority of a two-step surgery
strategy.29 In
addition, it is still inconclusive whether PLND can be completely
replaced by SLNB in early-stage cervical cancer. For these reasons,
intraoperative pathological diagnosis remains an important element in
SLNB for cervical cancer. Despite wide recognition, the benefits of SLNB
in cervical cancer have long been confined by the lack of precise
intraoperative pathology.18Similar dilemmas are also
encountered in other malignancies such as gastric
cancer.55 The major contribution of this meta-analysis
is that, for the first time, we identified a simple method to achieve
more precise intraoperative SLN assessment, which enables immediate
decision-making for individualized treatments.7