The false-negative rate of sentinel lymph node biopsy and its related factors in early-stage cervical cancer: a systematic review and meta-analysis

Background and purpose: The objective of this systematic review and meta-analysis was to evaluate the false-negative rate (FNR) of sentinel lymph node biopsy (SLNB) performed in patients with early-stage cervical cancer (ECC), and to study the risk factors affecting FNR.Material and methods: We searched three databases (Embase, MEDLINE, and Cochrane Central Library) for articles published in the last decade from January 2014 to September 2024. Publications on patients with ECC who underwent SLNB, with information on the FNR of SLNB, were included. The QUADAS-2 tool was used to assess the risk of bias and the clinical applicability of the included studies. The FNR and associated factors were synthesized using random-effects meta-analysis and meta-regression.Results: A total of 49 eligible studies with a low to moderate risk of bias were included in the final analysis. The overall FNR was 10.9% (95 CI: 6.0–16.7). No significant differences in FNR were found for different reference standards or tumor diameters (< 2 cm vs. ≥ 2 cm). However, different tracers (e.g. methylene blue [MB], carbon nanoparticle [CNP], indocyanine green [ICG], and Technetium-99m [Tc-99m] combined with other tracers) appear to account for the different FNRs. In the meta-regression analysis, we found that the proportion of SLNs located in the obturator area was significantly negatively associated with FNR (coefficient = −0.88, p = 0.04). Interpretation: The overall FNR of SLNB for ECC was approximately 10.9%. Factors that tended to reduce the FNR included using a low-volume metastatic detection technique, having a tumor diameter of < 2 cm, employing specific tracer regimens, and identifying more than one lymph node in the obturator fossa. Registration: PROSPERO (CRD42024608411)