A Prospective Cohort Study Comparing Colorimetric and Fluorescent Imaging for Sentinel Lymph Node Mapping in Endometrial Cancer

Abstract

In this prospective study, ISB + ICG and NIR detected more SLNs and more LN metastases than ISB alone. Assessment of SLN with ICG + ISB/NIR imaging had excellent sensitivity for detection of metastasis and no safety issues.

Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations

“…The ICG signal penetrates tissues, but also allows for real-time visualization during dissection, combining the assets of colorimetric and radionuclear techniques. ICG has been shown superior to blue dyes for detection, particularly in obese patients [34–37]. The only disadvantage of this tracer is the requirement for specialized NIR imaging equipment.…”

“…The tracer should be injected slowly into the submucosa or superficial cervical stroma to maximize lymphatic uptake and minimize staining of deep pelvic tissues. Increasing evidence suggests that cervical injection preserves the accuracy of detection of pelvic metastatic disease [37,64] in comprehensively staged patients, which may result from the confluence of lymphatic pathways from different regions of the uterus exiting the cervix through the lateral parametria. It is likely that some para-aortic lymph nodes are reached only via the lymphatics in the infundibulo-pelvic ligaments through deeper cervical injections; however, the accuracy of para-aortic mapping has not been fully investigated or reported.…”

“…Studies of comprehensively staged patients have shown that residual metastatic disease is present in non-SLN’s in approximately 40% of patients {37, 87]. Careful attention to the appearance of the non-SLN per the surgical algorithm is critically important, and suspiciously enlarged nodes should be removed.…”

“…Similar collaborative efforts are ongoing to analyze data for higher risk endometrial cancer histology, including deeply myoinvasive carcinomas, as well as serous and clear cell carcinoma. Moreover, large singleinstitution prospective studies utilizing SLN cervical injection followed by pelvic and para-aortic lymphadenectomy to prospectively describe the detection rate and false-negative rate are ongoing, and the encouraging results of these investigations have been recently presented at the SGO and International Gynecologic Cancer Society (IGCS) Annual Meetings [37,79]. With increasing utilization of the SLN algorithm for staging throughout the United States, Canada and Europe, several investigators have proposed and launched registry studies to describe outcomes, quality, cost assessment, and survival data.…”

Role of Sentinel Node Biopsy in Endometrial Cancer

“…The meta-analyses by Kang et al [25] and Bodurtha-Smith et al [26] showed that hysteroscopic or subserosal injections were associated with lower performance (p < 0.05), while cervical administration was correlated with higher detection rates (92%; range, 62-100% [27]; p = 0.031) [4] and bilaterality (56 vs. 33%; p = 0.003) (bilaterality is defined as the detection of sentinel node on both sides of the pelvis). The disadvantage was lower detection of paraaortic drainage (95% CI 3.4-10.1%) compared with other techniques (7% cervical vs. 27% corporal; p = 0.001) [28][29][30][31].…”