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Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy

Conrad Harrison, Samuel Willis, Mary Rose Harvey, Rakhshan Kamran Orcid Logo, Ryckie G. Wade, Thomas Dobbs, Oliver Cassell

BJS Open, Volume: 9, Issue: 4

Swansea University Author: Thomas Dobbs

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DOI (Published version): https://doi.org/10.1093/bjsopen/zraf089

Abstract

BackgroundSentinel lymph node biopsy provides information about disease staging and the need for adjuvant therapy. The consequences of a false-negative result are potentially severe. The risk of a false-negative result should be quantified. The aims of this study were to estimate the sensitivity of...

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Published in: BJS Open
ISSN: 2474-9842
Published: Oxford Academic 2025
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The aims of this study were to estimate the sensitivity of sentinel lymph node biopsy based on studies following up patients for at least a mean or median of 5 years, appraise the risk of bias, and provide negative predictive value estimates across a range of pretest probabilities.MethodsOvid MEDLINE and Embase databases were searched from inception to 28 May 2025. Studies were screened independently and in duplicate, with a third author resolving conflicts. All original comparative and non-comparative English language research studies were included if the sensitivity of sentinel lymph node biopsy was calculable and participants had been followed up for a mean or median of 5 years. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity estimates were calculated and pooled by random-effects meta-analysis. A negative predictive value curve was plotted using the pooled sensitivity estimate and a range of plausible pretest probabilities.ResultsFourteen studies with 8447 patients were included. The pooled sensitivity estimate was 0.85 (95% confidence interval 0.80 to 0.88). The negative predictive value estimates fell between 0.93 and 0.97, depending on pretest probability. Existing negative predictive value estimates are at risk of positive bias.ConclusionSentinel lymph node biopsy is a sensitive test used to rule out lymph node metastasis in cutaneous melanoma. 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spelling 2025-09-03T14:36:59.1190706 v2 70219 2025-08-22 Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy d18101ae0b4e72051f735ef68f45e1a8 Thomas Dobbs Thomas Dobbs true false 2025-08-22 MEDS BackgroundSentinel lymph node biopsy provides information about disease staging and the need for adjuvant therapy. The consequences of a false-negative result are potentially severe. The risk of a false-negative result should be quantified. The aims of this study were to estimate the sensitivity of sentinel lymph node biopsy based on studies following up patients for at least a mean or median of 5 years, appraise the risk of bias, and provide negative predictive value estimates across a range of pretest probabilities.MethodsOvid MEDLINE and Embase databases were searched from inception to 28 May 2025. Studies were screened independently and in duplicate, with a third author resolving conflicts. All original comparative and non-comparative English language research studies were included if the sensitivity of sentinel lymph node biopsy was calculable and participants had been followed up for a mean or median of 5 years. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity estimates were calculated and pooled by random-effects meta-analysis. A negative predictive value curve was plotted using the pooled sensitivity estimate and a range of plausible pretest probabilities.ResultsFourteen studies with 8447 patients were included. The pooled sensitivity estimate was 0.85 (95% confidence interval 0.80 to 0.88). The negative predictive value estimates fell between 0.93 and 0.97, depending on pretest probability. Existing negative predictive value estimates are at risk of positive bias.ConclusionSentinel lymph node biopsy is a sensitive test used to rule out lymph node metastasis in cutaneous melanoma. Clinicians can use negative predictive value estimates to counsel patients about the probability of false-negative results, for example, by offering reassurance to patients with thin melanomas and negative sentinel lymph node biopsy. Journal Article BJS Open 9 4 Oxford Academic 2474-9842 14 8 2025 2025-08-14 https://doi.org/10.1093/bjsopen/zraf089 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was supported by National Institute for Health and Care Research NIHR301792 and NIHR300684 (R.K. and C.H.). 2025-09-03T14:36:59.1190706 2025-08-22T12:09:16.2126484 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Conrad Harrison 1 Samuel Willis 2 Mary Rose Harvey 3 Rakhshan Kamran https://orcid.org/0000-0003-4298-4848 4 Ryckie G. Wade 5 Thomas Dobbs 6 Oliver Cassell 7 70219__34981__cb34eb2fd4cc448ab78e4de6d52025b3.pdf 70219.VoR.pdf 2025-08-22T12:14:46.8559690 Output 327688 application/pdf Version of Record true © The Author(s) 2025. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. true eng https://creativecommons.org/licenses/by/4.0/
title Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
spellingShingle Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
Thomas Dobbs
title_short Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
title_full Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
title_fullStr Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
title_full_unstemmed Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
title_sort Sensitivity and negative predictive value of sentinel lymph node biopsy for cutaneous melanoma for diagnosing nodal metastasis: meta-analysis of diagnostic test accuracy
author_id_str_mv d18101ae0b4e72051f735ef68f45e1a8
author_id_fullname_str_mv d18101ae0b4e72051f735ef68f45e1a8_***_Thomas Dobbs
author Thomas Dobbs
author2 Conrad Harrison
Samuel Willis
Mary Rose Harvey
Rakhshan Kamran
Ryckie G. Wade
Thomas Dobbs
Oliver Cassell
format Journal article
container_title BJS Open
container_volume 9
container_issue 4
publishDate 2025
institution Swansea University
issn 2474-9842
doi_str_mv https://doi.org/10.1093/bjsopen/zraf089
publisher Oxford Academic
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
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description BackgroundSentinel lymph node biopsy provides information about disease staging and the need for adjuvant therapy. The consequences of a false-negative result are potentially severe. The risk of a false-negative result should be quantified. The aims of this study were to estimate the sensitivity of sentinel lymph node biopsy based on studies following up patients for at least a mean or median of 5 years, appraise the risk of bias, and provide negative predictive value estimates across a range of pretest probabilities.MethodsOvid MEDLINE and Embase databases were searched from inception to 28 May 2025. Studies were screened independently and in duplicate, with a third author resolving conflicts. All original comparative and non-comparative English language research studies were included if the sensitivity of sentinel lymph node biopsy was calculable and participants had been followed up for a mean or median of 5 years. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity estimates were calculated and pooled by random-effects meta-analysis. A negative predictive value curve was plotted using the pooled sensitivity estimate and a range of plausible pretest probabilities.ResultsFourteen studies with 8447 patients were included. The pooled sensitivity estimate was 0.85 (95% confidence interval 0.80 to 0.88). The negative predictive value estimates fell between 0.93 and 0.97, depending on pretest probability. Existing negative predictive value estimates are at risk of positive bias.ConclusionSentinel lymph node biopsy is a sensitive test used to rule out lymph node metastasis in cutaneous melanoma. Clinicians can use negative predictive value estimates to counsel patients about the probability of false-negative results, for example, by offering reassurance to patients with thin melanomas and negative sentinel lymph node biopsy.
published_date 2025-08-14T07:49:39Z
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