Indocyanine green-guided sentinel node navigation surgery in early gastric cancer: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed the feasibility and diagnostic performance of indocyanine green (ICG)-guided sentinel node navigation surgery (SNNS) in selected patients with early gastric cancer. Across nine non-overlapping cohorts, the pooled sentinel-node identification rate was 99.9% (95% CI = 98.7-100.0%; I 2 = 32.0%). Eight studies provided patient-level diagnostic data; pooled sensitivity was 98.5% (95% CI 86.6-100.0%; I 2 = 47.6%). The findings support technical feasibility and promising sensitivity, but do not establish oncological non-inferiority of limited surgery.

Key findings

• The pooled identification rate was 99.9% (95% CI = 98.7-100.0%; I 2 = 32.0%) across nine non-overlapping cohorts.
• Patient-level sensitivity was 98.5% (95% CI 86.6-100.0%; I 2 = 47.6%) in eight studies with valid diagnostic data.
• Specificity was 100.0% (577/577), but estimation was constrained because all studies reported zero false positives.
• Evidence after non-curative ESD was heterogeneous and was synthesized narratively rather than pooled.

Why it matters

Reliable sentinel-node identification and high pooled sensitivity suggest that ICG-guided SNNS may help support individualized surgical approaches for selected patients with early gastric cancer. However, diagnostic performance alone does not show that limited surgery provides oncological outcomes equivalent to standard surgery. False-negative consequences and the constraints of the available evidence remain important when interpreting potential clinical use.

What to keep in mind

The evidence was concentrated in high-volume Asian centres, with cohort overlap, heterogeneous pathology, and zero false positives constraining diagnostic estimates. Evidence after non-curative ESD was heterogeneous, and the analysis does not establish oncological non-inferiority.