Combined use of ICG and technetium does not improve sentinel lymph node detection in endometrial cancer: Results of the COMBITEC study

Cabrera, Sílvia; Barahona, Marc; Almansa-González, Cristina; Padilla-Iserte, Pablo; Bebia, Vicente; Martí, Lola; Tejerizo-García, A.

doi:10.1016/j.ygyno.2021.05.002

Cited by 15 publications

(10 citation statements)

References 22 publications

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“…This rate is lower than that found by other authors. The FILM trial reported an “empty node packet” rate of 5% using only ICG [ 21 ], and Cabrera et al reported the rate of the absence of nodal tissue to be 4% using the combination Tc99 with ICG [ 22 ] and 0% using Tc99-methylene blue. In our study, injecting Tc99 and ICG in the same patient could help us better detect “real” lymph nodes in “green” tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Hybrid tracer (ICG and Tc99 in the same injection) would possibly summarize the advantages of both tracers: Tc99 would fix ICG avoiding the staining of the rest of the lymph nodes if, for any reason, the surgeon takes longer to dissect the lymph node area, and it could be injected intra-operatively. However, a recently Spanish retrospective study concluded that combined use of ICG and Tc99 did not improve SLN detection rates in endometrial cancer [ 22 ] although randomized prospective studies would be necessary. Sanchez-Izquierdo et al reported a low overall detection rate (69%) and a bilateral pelvic detection of 56% using a hybrid tracer (ICG–Tc99) injected using the TUMIR approach [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer—A Multidisciplinary Exhaustive Approach to Nodal Staging

Torrent

Amengual

Sampol

et al. 2022

Cancers

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Introduction: Sentinel lymph node (SLN) has recently been introduced as a standard staging technique in endometrial cancer (EC). There are some issues regarding team experience and para-aortic detection. Objective: to report the accuracy of SLN detection in EC with a dual tracer (ICG and Tc99) and dual injection site (cervix and fundus) during the learning curve. Methods: A prospective, observational single-center trial including 48 patients diagnosed with early-stage EC. Dual intracervical tracer (Tc99 and ICG) was injected at different times. High-risk patients had a second fundus injection with both tracers. Results: the detection rates were as follows: 100% (48/48) overall for SLNs; 98% (47/48) overall for pelvic SLNs; 89.5% (43/48) for bilateral SLNs; and 2% (1/48) for isolated para-aortic SLNs. In high-risk patients, the para-aortic overall DR was 66.7% (22/33); 60.7% (17/28) with ICG and 51.5% (17/33) with Tc99 (p = 0.048)). Overall rate of lymph node involvement was 14.6% (7/48). Macroscopic pelvic metastasis was found in four patients (8.3%) and microscopic in one case (2%). No metastasis was found in any para-aortic SLNs. Half of the patients with positive pelvic SLNs had positive para-aortic nodes. In high-risk patients, when para-aortic SLNs mapped failed, 36.4% (4/11) had positive nodes in para-aortic lymphadenectomy. The sensitivity and negative predictive value (NPV) of SLN pelvic detection was 100%. Conclusions: Multidisciplinary exhaustive approach gives a suitable accuracy of SLN during learning curve. Dual injection (cervical and fundal) with dual tracer (ICG and Tc99) offers good overall detection rates and increases para-aortic SLN detection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer—A Multidisciplinary Exhaustive Approach to Nodal Staging

Torrent

Amengual

Sampol

et al. 2022

Cancers

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“…One prospective study compared blue dye alone to ICG alone and found a significantly higher detection rate with ICG (90.9% vs. 64.4%) [ 38 ]. The COMBITEC study compared the combination of ICG and Tc-99 to ICG alone and found similar bilateral pelvic and para-aortic mapping rates, concluding that there is no benefit to addition of Tc-99 over ICG alone [ 43 ]. Systematic reviews and meta-analyses of over 40 published trials comparing different tracers report that ICG has the highest pooled detection rate (90–94%) [ 44 , 45 , 46 ].…”

Section: Sentinel Lymph Node Mapping In Endometrial Cancermentioning

confidence: 99%

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

et al. 2022

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Sentinel lymph node (SLN) mapping is becoming an acceptable alternative to full lymphadenectomy for evaluating lymphatic spread in clinical stage I endometrial cancer (EC). While the assessment of pelvic and para-aortic lymph nodes is part of the surgical staging of EC, there is a long-standing debate over the therapeutic value of full lymphadenectomy in this setting. Although lymphadenectomy offers critical information on lymphatic spread and prognosis, most patients will not derive oncologic benefit from this procedure as the majority of patients do not have lymph node involvement. SLN mapping offers prognostic information while simultaneously avoiding the morbidity associated with an extensive and often unnecessary lymphadenectomy. A key factor in the decision making when planning for EC surgery is the histologic subtype. Since the risk of lymphatic spread is less than 5% in low-grade EC, these patients might not benefit from lymph node assessment. Nonetheless, in high-grade EC, the risk for lymph node metastases is much higher (20–30%); therefore, it is crucial to determine the spread of disease both for determining prognosis and for tailoring the appropriate adjuvant treatment. Studies on the accuracy of SLN mapping in high-grade EC have shown a detection rate of over 90%. The available evidence supports adopting the SLN approach as an accurate method for surgical staging. However, there is a paucity of prospective data on the long-term oncologic outcome for patients undergoing SLN mapping in high-grade EC, and more trials are warranted to answer this question.

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“…ICG is superior to combined blue dye and Tc-99m, with higher SLN detection rate (100% vs 96%) and bilateral mapping rate (98.5% vs 76.3%) 25 . The COMBITEC study concluded that there is no benefit to add Tc-99m to ICG, owing to increased procedure time and no difference in the SLN detection rate 26 .…”

Section: What Tracer To Inject?mentioning

confidence: 99%

Sentinel lymph node mapping in endometrial cancer: an updated review

Lee

2022

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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lymph node mapping (SLNM) is widely used in staging of both low-and high-risk early-stage endometrial cancer. It has a high detection rate, high sensitivity, high negative predictive value, and low false negative rate in detection of lymph node metastasis. Cervical injection of indocyanine green for SLNM is the preferred method. SLNM reduces the number of lymph node removal and reduces complications from lymphadenectomy without compromising oncological safety. This review discusses the latest evidence of SLNM in endometrial cancer staging in terms of technique, accuracy, limitations, impact on lymphadenectomy complications, and cancer survival.

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Combined use of ICG and technetium does not improve sentinel lymph node detection in endometrial cancer: Results of the COMBITEC study

Cited by 15 publications

References 22 publications

Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer—A Multidisciplinary Exhaustive Approach to Nodal Staging

Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer—A Multidisciplinary Exhaustive Approach to Nodal Staging

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

Sentinel lymph node mapping in endometrial cancer: an updated review

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