Sentinel node mapping for intra-thoracic malignancies: systematic review of the best available evidence

Sentinel node mapping is a new technique of lymph nodal staging in solid tumors, which can decrease the morbidity of regional lymph node dissection considerably. Intra-thoracic tumors including non-small cell lung cancer (NSCLC) and esophageal carcinoma (EC) are among the solid tumors in which sentinel node (SN) mapping has been applied. In the current systematic review, we gathered the best available evidence (systematic reviews) in this regard and presented the results in a systematic review format. We searched MEDLINE and SCOPUS since the inception till 13 December 2014 using the following keywords: (lung OR esophagus OR esophageal) AND sentinel AND (“systematic review” OR meta-analysis OR metaanalysis). No language limit was imposed on the search strategy. Systematic reviews and meta-analyses on SN mapping in EC or NSCLC were included in the current study. Narrative review articles were excluded from the study. Overall five systematic review were included. One of the included studies was on SN mapping in NSCLC and four were on EC. Overall detection rate and sensitivity for EC and NSCLC were high and both were related to mapping technique, pathological involvement of the mediastinal nodes, size and location of the tumors. SN mapping is feasible and highly accurate in EC and NSCLC. Attention to the technique (using radiotracers, peri-tumoral injection) and restriction of the patients to less advanced cases (cN0 and T1, 2) would ensure the best results with high detection rate and sensitivity.