Sentinel lymph node biopsy mapped with carbon nanoparticle suspensions in patients with cervical cancer: a systematic review and meta-analysis

Background The mapping technique significantly influences the detection rate of sentinel lymph nodes in cervical cancer. This study aims to evaluate the clinical efficacy of carbon nanoparticle suspensions (CNSs) in guiding sentinel lymph node biopsy (SLNB) for cervical cancer patients. Methods Systematic search of China National Knowledge Infrastructure, Cqvip, Wanfang, PubMed, EMBASE, Web of Science, and the Cochrane Library from inception until June 2024. Studies on cervical cancer patients receiving SLNB with CNSs are included. An individual participant data meta-analysis was conducted. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024569290). Results In total, 26 publications involving 1671 patients were analyzed. The overall detection rate of CNSs in SLNB for cervical cancer was 0.92, with bilateral and unilateral detection rates of 0.74 and 0.20, respectively. This detection rate exhibited a correlation with lesion size and the administration of neoadjuvant chemotherapy. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 0.93 (95% CI: 0.88-0.96, I-2 = 35.89%), 1.00 (95% CI: 0.98-1.00, I-2 = 90.01%), 216.84 (95% CI: 40.47-1161.85, I-2 = 77.68%), and 0.07 (95% CI: 0.05-0.12, I-2 = 54.96%), respectively. The area under the curve of the summary receiver operating characteristic curve was 0.97. No significant differences were found in subgroup analyses based on the method, time, and dose of CNS injection. However, significant publication bias was detected among the included studies based on Deeks' funnel plot [Slope (Bias) = -15.61, P = .001]. Nonetheless, sensitivity analysis confirmed the reliability and stability of the results. Conclusions This meta-analysis highlights the accuracy and feasibility of using CNSs for SLNB in patients with cervical cancer, particularly for lesions <2.0 cm and patients untreated with neoadjuvant chemotherapy.