23. Sentinel lymph node detection using icg in apparent early-stage endometrial cancer
Main Article Content
Abstract
Sentinel lymph node biopsy (SLNb) in endometrial cancer allows accurate assessment of lymph node status and reduces complications when compared with systematic lymph node dissection. Among the tracers used to identify sentinel lymph nodes, indocyanine green (ICG) is an effective dye, demonstrated by the high detection rate. We aim to report the primary results of lymphatic mapping and SLNb using ICG via laparoscopic or robotic surgery in apparent early-stage endometrial cancer. Nineteen patients underwent sentinel lymph node biopsy during comprehensive surgical staging, followed by routine lymphadenectomy. Median age was 56 years (range, 38 - 72 years), median BMI was 22.4 kg/m2 (range, 18.7 - 26.6). The overall detection rate was 100%, bilateral pelvic mapping was achieved in 94.7% of all patients, and the rate of detection of sentinel lymph nodes in the para-aortic areas was 21%. The median SLN count was 4 (range, 2 - 6). There were two cases of lymph node metastasis identified, both in the sentinel lymph nodes. There were no case of negative sentinel lymph nodes while non-sentinel lymph nodes were positive. SLNb using ICG is feasible with a high detection rate and initially proved reliable with no false negative case.
Article Details
Keywords
Endometrial cancer, sentinel lymph node biopsy, lymphatic mapping, indocyanine green
References
2. Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008; 100(23): 1707-1716. doi:10.1093/jnci/djn397.
3. ASTEC study group, Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet Lond Engl. 2009; 373(9658): 125-136. doi:10.1016/S0140-6736(08)61766-3.
4. Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009; 113(2): 163-169. doi:10.1016/j.ygyno.2009.01.003.
5. Abu-Rustum NR, Arend R, Barber E, et al. NCCN Guidelines Index Table of Contents Discussion. Published online 2024.
6. Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2021; 31(1): 12-39. doi:10.1136/ijgc-2020-002230.
7. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2016; 26(1): 2-30. doi:10.1097/IGC.0000000000000609.
8. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987; 60(8 Suppl): 2035-2041. doi:10.1002/1097-0142(19901015)60:8+<2035::aid-cncr2820601515>3.0.co;2-8.
9. Buda A, Di Martino G, Vecchione F, et al. Optimizing Strategies for Sentinel Lymph Node Mapping in Early-Stage Cervical and Endometrial Cancer: Comparison of Real-Time Fluorescence With Indocyanine Green and Methylene Blue. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2015; 25(8): 1513-1518. doi:10.1097/IGC.0000000000000526.
10. Papadia A, Zapardiel I, Bussi B, et al. Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99m with blue dye versus indocyanine green fluorescent dye. J Cancer Res Clin Oncol. 2017; 143(3): 475-480. doi:10.1007/s00432-016-2297-y.
11. How J, Gotlieb WH, Press JZ, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015; 137(3): 436-442. doi:10.1016/j.ygyno.2015.04.004.
12. Holloway RW, Bravo RAM, Rakowski JA, et al. Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: a comparison of colorimetric and fluorescence imaging. Gynecol Oncol. 2012; 126(1): 25-29. doi:10.1016/j.ygyno.2012.04.009.
13. Rossi EC, Kowalski LD, Scalici J, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017; 18(3): 384-392. doi:10.1016/S1470-2045(17)30068-2.
14. Frumovitz M, Plante M, Lee PS, et al. Near-infrared fluorescence for detection of sentinel lymph nodes in women with cervical and uterine cancers (FILM): a randomised, phase 3, multicentre, non-inferiority trial. Lancet Oncol. 2018; 19(10):1394-1403. doi:10.1016/S1470-2045(18)30448-0.
15. Mais V, Peiretti M, Gargiulo T, Parodo G, Cirronis MG, Melis GB. Intraoperative sentinel lymph node detection by vital dye through laparoscopy or laparotomy in early endometrial cancer. J Surg Oncol. 2010; 101(5): 408-412. doi:10.1002/jso.21496.
16. Ngọc PTH, Trinh, Dương Thị Ái, Quỳnh, Trần Thị Như, Quý, Trần Tứ. Ngiên cứu giá trị của sinh thiết hạch gác bằng xanh methylene trong điều trị ung thư nội mạc tử cung tại bệnh viện ung bướu Đà Nẵng. Tạp Chí Học Việt Nam. 2022; 520.
17. Ballester M, Dubernard G, Lécuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early-stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011; 12(5): 469-476. doi:10.1016/S1470-2045(11)70070-5.
18. Perrone AM, Casadio P, Formelli G, et al. Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol Oncol. 2008; 111(1): 62-67. doi:10.1016/j.ygyno.2008.05.032.
19. Ditto A, Martinelli F, Bogani G, Papadia A, Lorusso D, Raspagliesi F. Sentinel node mapping using hysteroscopic injection of indocyanine green and laparoscopic near-infrared fluorescence imaging in endometrial cancer staging. J Minim Invasive Gynecol. 2015; 22(1): 132-133. doi:10.1016/j.jmig.2014.08.009.