Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis

Chen, Yongfeng; Xiao, Qi; Zou, Weina; Xia, Chengwan; Yin, Hongling; Pu, Yumei; Wang, Yuxin; Zhang, Kai

doi:10.6061/clinics/2021/e2573

Yongfeng Chen

Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.

# Contributed equally to this work.

http://orcid.org/0000-0002-5052-5353

Qi Xiao

Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.

# Contributed equally to this work.

http://orcid.org/0000-0001-8954-2700

Weina Zou

Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.

http://orcid.org/0000-0003-2235-6254

Chengwan Xia

Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.

http://orcid.org/0000-0003-3937-2605

Hongling Yin

Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.

http://orcid.org/0000-0003-0160-7878

Yumei Pu

Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.

http://orcid.org/0000-0002-6066-1228

Yuxin Wang ^**Corresponding authors. E-mails: zk29788@163.com / wangyuxin0212@126.com

Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.

http://orcid.org/0000-0002-1629-4176

Kai Zhang ^**Corresponding authors. E-mails: zk29788@163.com / wangyuxin0212@126.com

Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.

http://orcid.org/0000-0003-4052-942X

*Corresponding authors. E-mails: zk29788@163.com / wangyuxin0212@126.com

#
Contributed equally to this work.

No potential conflict of interest was reported.

AUTHOR CONTRIBUTIONS

Chen Y, Wang Y and Zhang K were responsible for the study design. Xiao Q, Zou W, Xia C and Yin H were responsible for the data acquisition and analysis. Xiao Q, Xia C, Yin H and Pu Y were responsible for the results interpretation, manuscript writing and revision.

Author	Year	Country	No.	Age (years)	Tumor	Reference test	Procedure	LNs	SLNs	SLN⁺	Mean SLNs	Follow-up
Hoon Kim et al. (⁸8. Kim JH, Byeon HK, Kim DH, Kim SH, Choi EC, Koh YW. ICG-Guided Sentinel Lymph Node Sampling during Robotic Retroauricular Neck Dissection in cN0 Oral Cancer. Otolaryngol Head Neck Surg. 2020;162(3):410-3. https://doi.org/10.1177/0194599819900264 https://doi.org/10.1177/0194599819900264... )	2020	South Korea	9	48	OSCC	pathology	RAND	313	31	5	3.4	No recurrence or metastasis were seen
Ishiguro et al. (⁹9. Ishiguro K, Iwai T, Izumi T, Sugiyama S, Baba J, Oguri S, et al. Sentinel lymph node biopsy with preoperative CT lymphography and intraoperative indocyanine green fluorescence imaging for N0 early tongue cancer: A long-term follow-up study. J Craniomaxillofac Surg. 2020;48(3):217-22. https://doi.org/10.1016/j.jcms.2020.01.007 https://doi.org/10.1016/j.jcms.2020.01.0... )	2020	Japan	27	65	tongue cancer	pathology	SND	ND	41	5	1.5	76 months, 3 of 22 patients without SLN metastasis had occult cervical lymph node metastasis, and 1 SLN positive case recurred
Honda et al. (¹⁰10. Honda K, Ishiyama K, Suzuki S, Kawasaki Y, Saito H, Horii A. Sentinel Lymph Node Biopsy Using Preoperative Computed Tomographic Lymphography and Intraoperative Indocyanine Green Fluorescence Imaging in Patients With Localized Tongue Cancer. JAMA Otolaryngol Head Neck Surg. 2019;145(8):735-40. https://doi.org/10.1001/jamaoto.2019.1243 https://doi.org/10.1001/jamaoto.2019.124... )	2019	Japan	16	65.5	tongue cancer	pathology	SND	ND	30	5	1.9	38 months, neck recurrence was found in 2 of the 11 patients who initially showed metastasis-negative SLNs
Meershoek et al. (¹¹11. Meershoek P, van den Berg NS, Brouwer OR, Teertstra HJ, Lange CAH, Valdés-Olmos RA, et al. Three-Dimensional Tumor Margin Demarcation Using the Hybrid Tracer Indocyanine Green-99mTc-Nanocolloid: A Proof-of-Concept Study in Tongue Cancer Patients Scheduled for Sentinel Node Biopsy. J Nucl Med. 2019;60(6):764-9. https://doi.org/10.2967/jnumed.118.220202 https://doi.org/10.2967/jnumed.118.22020... )	2019	Netherlands	19	59	tongue cancer	pathology	SND	69	60	5	3.2	-
KleinJan et al. (¹²12. KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, et al. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging. 2018;45(11):1915-25. https://doi.org/10.1007/s00259-018-4028-x https://doi.org/10.1007/s00259-018-4028-... )	2018	Netherlands	51	61	OSCC	pathology	SND	357	293	10	5.7	33 months, false negative findings of oral cavity patients occurred in the first 15 cases
Digonnet et al. (¹³13. Digonnet A, van Kerckhove S, Moreau M, Willemse E, Quiriny M, Ahmed B, et al. Near infrared fluorescent imaging after intravenous injection of indocyanine green during neck dissection in patients with head and neck cancer: A feasibility study. Head Neck. 2016;38(4) Suppl 1:E1833-7. https://doi.org/10.1002/hed.24331 https://doi.org/10.1002/hed.24331... )	2016	Belgium	2	56.5	oral cancer	pathology	SND	23	1	1	-	3-22 months (0 recurrence)
Christensen et al. (¹⁴14. Christensen A, Juhl K, Charabi B, Mortensen J, Kiss K, Kjær A, et al. Feasibility of Real-Time Near-Infrared Fluorescence Tracer Imaging in Sentinel Node Biopsy for Oral Cavity Cancer Patients. Ann Surg Oncol. 2016;23(2):565-72. https://doi.org/10.1245/s10434-015-4883-7 https://doi.org/10.1245/s10434-015-4883-... )	2016	Denmark	30	64	OSCC	pathology	SND	ND	94	6	3.1	-
Peng et al. (¹⁵15. Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol. 2015;13:278. https://doi.org/10.1186/s12957-015-0691-6 https://doi.org/10.1186/s12957-015-0691-... )	2015	China	19	60.5	OSCC	pathology	SND (18)RND (1)	420	61	5	3.2	-
Nakamura et al. (¹⁶16. Nakamura T, Kogashiwa Y, Nagafuji H, Yamauchi K, Kohno N. Validity of sentinel lymph node biopsy by ICG fluorescence for early head and neck cancer. Anticancer Res. 2015;35(3):1669-74.)	2015	Japan	3	-	tongue cancer	pathology	SND	ND	8	1	2.7	No recurrence or metastasis were seen
Murase et al. (¹⁷17. Murase R, Tanaka H, Hamakawa T, Goda H, Tano T, Ishikawa A, et al. Double sentinel lymph node mapping with indocyanine green and 99m-technetium-tin colloid in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2015;44(10):1212-7. https://doi.org/10.1016/j.ijom.2015.05.008 https://doi.org/10.1016/j.ijom.2015.05.0... )	2015	Japan	16	65.5	oral cancer	pathology	SND	ND	35	2	2.2	more than 3 years, (1 ICG imaging patient died of lung metastasis; no other signs of recurrence or metastasis were seen)
Borbón-Arce et al. (¹⁸18. Borbón-Arce M, Brouwer OR, van den Berg NS, Mathéron H, Klop WM, Balm AJ, et al. An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies. Rev Esp Med Nucl Imagen Mol. 2014;33(5):274-9. https://doi.org/10.1016/j.remnie.2014.06.015 https://doi.org/10.1016/j.remnie.2014.06... )	2014	Spain	9	60	OSCC	pathology	SND	30	30	6	3.3	-
Joost et al. (¹⁹19. van der Vorst JR, Schaafsma BE, Verbeek FP, Keereweer S, Jansen JC, van der Velden LA, et al. Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients. Oral Oncol. 2013;49(1):15-9. https://doi.org/10.1016/j.oraloncology.2012.07.017 https://doi.org/10.1016/j.oraloncology.2... )	2013	Germany	8	59.5	oral cancer	pathology	SND	184	15	2	1.9	-
Frontado et al. (²⁰20. Frontado ML, Brouwer OR, van den Berg NS, Mathéron HM, Vidal-Sicart S, van Leeuwen FW, et al. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Rev Esp Med Nucl Imagen Mol. 2013;32(4): 227-33. https://doi.org/10.1016/j.remnie.2013.05.015 https://doi.org/10.1016/j.remnie.2013.05... )	2013	Spain	3	52	OSCC	pathology	SND	6	6	1	2	-
Nynke et al. (²¹21. van den Berg NS, Miwa M, KleinJan GH, Sato T, Maeda Y, van Akkooi AC, et al. (Near-Infrared) Fluorescence-Guided Surgery Under Ambient Light Conditions: A Next Step to Embedment of the Technology in Clinical Routine. Ann Surg Oncol. 2016;23(8):2586-95. https://doi.org/10.1245/s10434-016-5186-3 https://doi.org/10.1245/s10434-016-5186-... )	2012	Netherlands	14	60.5	OSCC	pathology	SND	94	47	1	3.4	-

Author	Commercial name of ICG	Concentration	Dose	Detection method	Injection site	Equipment	Injection time	Fluorescent time
Hoon Kim et al. (⁸8. Kim JH, Byeon HK, Kim DH, Kim SH, Choi EC, Koh YW. ICG-Guided Sentinel Lymph Node Sampling during Robotic Retroauricular Neck Dissection in cN0 Oral Cancer. Otolaryngol Head Neck Surg. 2020;162(3):410-3. https://doi.org/10.1177/0194599819900264 https://doi.org/10.1177/0194599819900264... )		2.5 mg/ml	2 ml	ICG	peritumoral	Firefly system, robotic system,	preoperative	-
Ishiguro et al. (⁹9. Ishiguro K, Iwai T, Izumi T, Sugiyama S, Baba J, Oguri S, et al. Sentinel lymph node biopsy with preoperative CT lymphography and intraoperative indocyanine green fluorescence imaging for N0 early tongue cancer: A long-term follow-up study. J Craniomaxillofac Surg. 2020;48(3):217-22. https://doi.org/10.1016/j.jcms.2020.01.007 https://doi.org/10.1016/j.jcms.2020.01.0... )	Daiichi Sankyo Company, Tokyo, Japan	5 mg/ml	2 ml	ICG	peritumoral	CTL, near-infrared camera	intraoperative	-
Honda et al. (¹⁰10. Honda K, Ishiyama K, Suzuki S, Kawasaki Y, Saito H, Horii A. Sentinel Lymph Node Biopsy Using Preoperative Computed Tomographic Lymphography and Intraoperative Indocyanine Green Fluorescence Imaging in Patients With Localized Tongue Cancer. JAMA Otolaryngol Head Neck Surg. 2019;145(8):735-40. https://doi.org/10.1001/jamaoto.2019.1243 https://doi.org/10.1001/jamaoto.2019.124... )	Daiichi Pharmaceutical	5 mg/ml	2 ml	CT lymphography, ICG	peritumoral	FLAIR, near-infrared camera, HEMS, PDE	preoperative	1 min/2 min
Meershoek et al. (¹¹11. Meershoek P, van den Berg NS, Brouwer OR, Teertstra HJ, Lange CAH, Valdés-Olmos RA, et al. Three-Dimensional Tumor Margin Demarcation Using the Hybrid Tracer Indocyanine Green-99mTc-Nanocolloid: A Proof-of-Concept Study in Tongue Cancer Patients Scheduled for Sentinel Node Biopsy. J Nucl Med. 2019;60(6):764-9. https://doi.org/10.2967/jnumed.118.220202 https://doi.org/10.2967/jnumed.118.22020... )	ICG-Pulsion; Pulsion Medical Systems	1.25 mg/ml	80 MBq	ICG-^99mTc-nanocolloid	peritumoral	PDE, near-infrared camera,	preoperative	-
KleinJan et al. (¹²12. KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, et al. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging. 2018;45(11):1915-25. https://doi.org/10.1007/s00259-018-4028-x https://doi.org/10.1007/s00259-018-4028-... )	Pulsion Medical Systems, Múnich, Germany	1.25 mg/ml	81 MBq	ICG-^99mTc-nanocolloid, blue dye	peritumoral	SPECT/CT, near-infrared camera, γ-probe	preoperative	15 min/2 h
Digonnet et al. (¹³13. Digonnet A, van Kerckhove S, Moreau M, Willemse E, Quiriny M, Ahmed B, et al. Near infrared fluorescent imaging after intravenous injection of indocyanine green during neck dissection in patients with head and neck cancer: A feasibility study. Head Neck. 2016;38(4) Suppl 1:E1833-7. https://doi.org/10.1002/hed.24331 https://doi.org/10.1002/hed.24331... )	Pulsion Medical System, Belgium	0.25 mg/kg	-	ICG	intravenous	near-infrared camera	intraoperative	2 h
Christensen et al. (¹⁴14. Christensen A, Juhl K, Charabi B, Mortensen J, Kiss K, Kjær A, et al. Feasibility of Real-Time Near-Infrared Fluorescence Tracer Imaging in Sentinel Node Biopsy for Oral Cavity Cancer Patients. Ann Surg Oncol. 2016;23(2):565-72. https://doi.org/10.1245/s10434-015-4883-7 https://doi.org/10.1245/s10434-015-4883-... )	ICG-Pulsion,Pulsion Medical, Germany	0.25 mg/ml	0.2 ml	ICG-^99mTc -nanocolloid	peritumoral	SPECT/CT, near-infrared camera, γ-probe	preoperative	-
Peng et al. (¹⁵15. Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol. 2015;13:278. https://doi.org/10.1186/s12957-015-0691-6 https://doi.org/10.1186/s12957-015-0691-... )	Dandong, China	5 mg/ml	1 ml	blue dye, ICG	peritumoral	near-infrared camera	preoperative	10 min
Nakamura et al. (¹⁶16. Nakamura T, Kogashiwa Y, Nagafuji H, Yamauchi K, Kohno N. Validity of sentinel lymph node biopsy by ICG fluorescence for early head and neck cancer. Anticancer Res. 2015;35(3):1669-74.)	Daiichi Sankyo, Tokyo, Japan	2.5 mg/ml	0.5 ml	^99mTc, ICG	peritumoral	HEMS monitor,	preoperative	19.8±12.6 min
Murase et al. (¹⁷17. Murase R, Tanaka H, Hamakawa T, Goda H, Tano T, Ishikawa A, et al. Double sentinel lymph node mapping with indocyanine green and 99m-technetium-tin colloid in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2015;44(10):1212-7. https://doi.org/10.1016/j.ijom.2015.05.008 https://doi.org/10.1016/j.ijom.2015.05.0... )	Diagnogreen; Daiichi Pharmaceutical, Tokyo, Japan	5 mg/ml	0.4 ml	ICG	peritumoral	γ-probe	intraoperative	2 h
Borbón-Arce et al. (¹⁸18. Borbón-Arce M, Brouwer OR, van den Berg NS, Mathéron H, Klop WM, Balm AJ, et al. An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies. Rev Esp Med Nucl Imagen Mol. 2014;33(5):274-9. https://doi.org/10.1016/j.remnie.2014.06.015 https://doi.org/10.1016/j.remnie.2014.06... )	ICG-Pulsion, Pulsion Medical Systems, Múnich, Germany	2.5 mg/ml	85 MBq	ICG-^99m Tc-nanocolloid	peritumoral	SPECT/CT, near-infrared camera, γ-probe, PDE	preoperative	15 min/2 h
Joost et al. (¹⁹19. van der Vorst JR, Schaafsma BE, Verbeek FP, Keereweer S, Jansen JC, van der Velden LA, et al. Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients. Oral Oncol. 2013;49(1):15-9. https://doi.org/10.1016/j.oraloncology.2012.07.017 https://doi.org/10.1016/j.oraloncology.2... )	Pulsion Medical Systems (Múnich, Germany)	2.5 mg/ml	1.6 mL	blue dye, ICG-^99m Tc, HSA	peritumoral	Mini-FLARE imaging system	preoperative	5/10/15/30 min
Frontado et al. (²⁰20. Frontado ML, Brouwer OR, van den Berg NS, Mathéron HM, Vidal-Sicart S, van Leeuwen FW, et al. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Rev Esp Med Nucl Imagen Mol. 2013;32(4): 227-33. https://doi.org/10.1016/j.remnie.2013.05.015 https://doi.org/10.1016/j.remnie.2013.05... )	ICG-Pulsion, Pulsion Medical Systems, Múnich, Alemania	5 mg/ml	86.5 MBq	ICG-^99m Tc-nanocolloid	peritumoral	SPECT/CT, γ- camera	preoperative	10 min/15 min/2 h
Nynke et al. (²¹21. van den Berg NS, Miwa M, KleinJan GH, Sato T, Maeda Y, van Akkooi AC, et al. (Near-Infrared) Fluorescence-Guided Surgery Under Ambient Light Conditions: A Next Step to Embedment of the Technology in Clinical Routine. Ann Surg Oncol. 2016;23(8):2586-95. https://doi.org/10.1245/s10434-016-5186-3 https://doi.org/10.1245/s10434-016-5186-... )	Pulsion Medical Systems, Múnich, Germany	2.5 mg/ml	0.4 ml	ICG-^99m Tc -nanocolloid	peritumoral	SPECT/CT, near-infrared camera, γ-probe,	preoperative	3-19 h

Author	TP	FP	FN	TN
Hoon Kim et al. (⁸8. Kim JH, Byeon HK, Kim DH, Kim SH, Choi EC, Koh YW. ICG-Guided Sentinel Lymph Node Sampling during Robotic Retroauricular Neck Dissection in cN0 Oral Cancer. Otolaryngol Head Neck Surg. 2020;162(3):410-3. https://doi.org/10.1177/0194599819900264 https://doi.org/10.1177/0194599819900264... )	5	26	0	282
Meershoek et al. (¹¹11. Meershoek P, van den Berg NS, Brouwer OR, Teertstra HJ, Lange CAH, Valdés-Olmos RA, et al. Three-Dimensional Tumor Margin Demarcation Using the Hybrid Tracer Indocyanine Green-99mTc-Nanocolloid: A Proof-of-Concept Study in Tongue Cancer Patients Scheduled for Sentinel Node Biopsy. J Nucl Med. 2019;60(6):764-9. https://doi.org/10.2967/jnumed.118.220202 https://doi.org/10.2967/jnumed.118.22020... )	5	55	0	9
KleinJan et al. (¹²12. KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, et al. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging. 2018;45(11):1915-25. https://doi.org/10.1007/s00259-018-4028-x https://doi.org/10.1007/s00259-018-4028-... )	10	283	0	64
Digonnet et al. (¹³13. Digonnet A, van Kerckhove S, Moreau M, Willemse E, Quiriny M, Ahmed B, et al. Near infrared fluorescent imaging after intravenous injection of indocyanine green during neck dissection in patients with head and neck cancer: A feasibility study. Head Neck. 2016;38(4) Suppl 1:E1833-7. https://doi.org/10.1002/hed.24331 https://doi.org/10.1002/hed.24331... )	1	0	0	22
Peng et al. (¹⁵15. Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol. 2015;13:278. https://doi.org/10.1186/s12957-015-0691-6 https://doi.org/10.1186/s12957-015-0691-... )	5	56	0	359
Borbón-Arce et al. (¹⁸18. Borbón-Arce M, Brouwer OR, van den Berg NS, Mathéron H, Klop WM, Balm AJ, et al. An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies. Rev Esp Med Nucl Imagen Mol. 2014;33(5):274-9. https://doi.org/10.1016/j.remnie.2014.06.015 https://doi.org/10.1016/j.remnie.2014.06... )	6	24	0	0
Joost et al. (¹⁹19. van der Vorst JR, Schaafsma BE, Verbeek FP, Keereweer S, Jansen JC, van der Velden LA, et al. Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients. Oral Oncol. 2013;49(1):15-9. https://doi.org/10.1016/j.oraloncology.2012.07.017 https://doi.org/10.1016/j.oraloncology.2... )	2	13	1	118
Frontado et al. (²⁰20. Frontado ML, Brouwer OR, van den Berg NS, Mathéron HM, Vidal-Sicart S, van Leeuwen FW, et al. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Rev Esp Med Nucl Imagen Mol. 2013;32(4): 227-33. https://doi.org/10.1016/j.remnie.2013.05.015 https://doi.org/10.1016/j.remnie.2013.05... )	1	5	0	0
Nynke et al. (²¹21. van den Berg NS, Miwa M, KleinJan GH, Sato T, Maeda Y, van Akkooi AC, et al. (Near-Infrared) Fluorescence-Guided Surgery Under Ambient Light Conditions: A Next Step to Embedment of the Technology in Clinical Routine. Ann Surg Oncol. 2016;23(8):2586-95. https://doi.org/10.1245/s10434-016-5186-3 https://doi.org/10.1245/s10434-016-5186-... )	1	46	0	47
Total	36	508	1	901

				Factors that may decrease certainty of evidence
Study	Outcome	No. of patients	Study design	Risk of bias	Indirectness	Inconsistency	Imprecision	publication bias	Test accuracy CoE
Hoon Kim et al. (⁸8. Kim JH, Byeon HK, Kim DH, Kim SH, Choi EC, Koh YW. ICG-Guided Sentinel Lymph Node Sampling during Robotic Retroauricular Neck Dissection in cN0 Oral Cancer. Otolaryngol Head Neck Surg. 2020;162(3):410-3. https://doi.org/10.1177/0194599819900264 https://doi.org/10.1177/0194599819900264... )	sensitivity	9	cross-sectional	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
	specificity		(-1)^a	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
Meershoek et al. (¹¹11. Meershoek P, van den Berg NS, Brouwer OR, Teertstra HJ, Lange CAH, Valdés-Olmos RA, et al. Three-Dimensional Tumor Margin Demarcation Using the Hybrid Tracer Indocyanine Green-99mTc-Nanocolloid: A Proof-of-Concept Study in Tongue Cancer Patients Scheduled for Sentinel Node Biopsy. J Nucl Med. 2019;60(6):764-9. https://doi.org/10.2967/jnumed.118.220202 https://doi.org/10.2967/jnumed.118.22020... )	sensitivity	19	cross-sectional	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
	specificity		(-1)^a	not serious	not serious	(-1)^b	not serious	not serious	⊕⊕○○/C
KleinJan et al. (¹²12. KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, et al. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging. 2018;45(11):1915-25. https://doi.org/10.1007/s00259-018-4028-x https://doi.org/10.1007/s00259-018-4028-... )	sensitivity	51	cross-sectional	not serious	not serious	(+1)	not serious	not serious	⊕⊕⊕⊕/A
	specificity	51	(-1)^a	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
Digonnet et al. (¹³13. Digonnet A, van Kerckhove S, Moreau M, Willemse E, Quiriny M, Ahmed B, et al. Near infrared fluorescent imaging after intravenous injection of indocyanine green during neck dissection in patients with head and neck cancer: A feasibility study. Head Neck. 2016;38(4) Suppl 1:E1833-7. https://doi.org/10.1002/hed.24331 https://doi.org/10.1002/hed.24331... )	Sensitivity	2	cross-sectional	not serious	not serious	not serious	(-1)^c	not serious	⊕⊕○○/C
	specificity	2	(-1)^a	not serious	not serious	not serious	(-1)^c	not serious	⊕⊕○○/C
Peng et al. (¹⁵15. Peng H, Wang SJ, Niu X, Yang X, Chi C, Zhang G. Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer. World J Surg Oncol. 2015;13:278. https://doi.org/10.1186/s12957-015-0691-6 https://doi.org/10.1186/s12957-015-0691-... )	Sensitivity	19	cross-sectional	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
	specificity	19	(-1)^a	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
Borbón-Arce et al. (¹⁸18. Borbón-Arce M, Brouwer OR, van den Berg NS, Mathéron H, Klop WM, Balm AJ, et al. An innovative multimodality approach for sentinel node mapping and biopsy in head and neck malignancies. Rev Esp Med Nucl Imagen Mol. 2014;33(5):274-9. https://doi.org/10.1016/j.remnie.2014.06.015 https://doi.org/10.1016/j.remnie.2014.06... )	Sensitivity	9	cross-sectional	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
	specificity	9	(-1)^a	not serious	not serious	(-1)^b	not serious	not serious	⊕⊕○○/C
Joost et al. (¹⁹19. van der Vorst JR, Schaafsma BE, Verbeek FP, Keereweer S, Jansen JC, van der Velden LA, et al. Near-infrared fluorescence sentinel lymph node mapping of the oral cavity in head and neck cancer patients. Oral Oncol. 2013;49(1):15-9. https://doi.org/10.1016/j.oraloncology.2012.07.017 https://doi.org/10.1016/j.oraloncology.2... )	Sensitivity	8	cross-sectional	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
	specificity	8	(-1)^a	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
Frontado et al. (²⁰20. Frontado ML, Brouwer OR, van den Berg NS, Mathéron HM, Vidal-Sicart S, van Leeuwen FW, et al. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Rev Esp Med Nucl Imagen Mol. 2013;32(4): 227-33. https://doi.org/10.1016/j.remnie.2013.05.015 https://doi.org/10.1016/j.remnie.2013.05... )	Sensitivity	3	cross-sectional	not serious	not serious	not serious	(-1)^c	not serious	⊕⊕○○/C
	specificity	3	(-1)^a	not serious	not serious	not serious	(-1)^c	not serious	⊕⊕○○/C
Nynke et al. (²¹21. van den Berg NS, Miwa M, KleinJan GH, Sato T, Maeda Y, van Akkooi AC, et al. (Near-Infrared) Fluorescence-Guided Surgery Under Ambient Light Conditions: A Next Step to Embedment of the Technology in Clinical Routine. Ann Surg Oncol. 2016;23(8):2586-95. https://doi.org/10.1245/s10434-016-5186-3 https://doi.org/10.1245/s10434-016-5186-... )	Sensitivity	14	cross-sectional	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B
	specificity	14	(-1)^a	not serious	not serious	not serious	not serious	not serious	⊕⊕⊕○/B

[1] *Corresponding authors. E-mails: zk29788@163.com / wangyuxin0212@126.com

Brasil

Brasil

Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis