Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer 99mTc and/or Blue Dye

Abstract

PurposeTo compare the detection rate (DR) and bilateral optimal mapping (OM) of sentinel lymph nodes (SLNs) in women with endometrial and cervical cancer using indocyanine green (ICG) versus the standard technetium-99m radiocolloid (99mTc) radiotracer plus methylene or isosulfan blue, or blue dye alone.MethodsFrom October 2010 to May 2015, 163 women with stage I endometrial or cervical cancer (118 endometrial and 45 cervical cancer) underwent SLN mapping with 99mTc with blue dye, blue dye alone, or ICG. DR and bilateral OM of ICG were compared respectively with the results obtained using the standard 99mTc radiotracer with blue dye, or blue dye alone.ResultsSLN mapping with 99mTc radiotracer with blue dye was performed on 77 of 163 women, 38 with blue dye only and 48 with ICG. The overall DR of SLN mapping was 97, 89, and 100 % for 99mTc with blue dye, blue dye alone, and ICG, respectively. The bilateral OM rate for ICG was 85 %—significantly higher than the 58 % obtained with 99mTc with blue dye (p = 0.003) and the 54 % for blue dye (p = 0.001). Thirty-one women (19 %) had positive SLNs. Sensitivity and negative predictive value of SLN were 100 % for all techniques.ConclusionsSLNs mapping using ICG demonstrated higher DR compared to other modalities. In addition, ICG was significantly superior to 99mTc with blue dye in terms of bilateral OM in women with early stage endometrial and cervical cancer. The higher number of bilateral OM may consequently reduce the overall number of complete lymphadenectomies, reducing the duration and additional costs of surgical treatment.

Sentinel Node Biopsy in Endometrial Cancer With Dual Cervical and Fundal Indocyanine Green Injection

“…Current data favor the use of ICG. 14,15 The entire procedure takes place in the operating room after anesthesia, sparing the patient any discomfort. Its optimal visibility identifies fluorescent LNs very clearly and helps locate SLNs in unusual places and over a broad area.…”

Preoperative Serum Human Epididymis Protein 4 Levels in Early Stage Endometrial Cancer: A Prospective Study

“…26 As previously discussed, recent data on the role of sentinel lymph node (SLN) in the surgical staging of early EC staging are changing the paradigms of surgical management of this disease. 27 In addition, the introduction of the green indocyanine for the SLN mapping has significantly increased the detection rate of this technique, 28 and the availability of new imaging technology further increases the number of EC patients enrolled. To date, in most referral gynecological cancer centers, prospective trials on survival impact of SLN in early EC are ongoing.…”

Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer

“…Additionally, ICG dye is injected while the patient is under anesthesia, which avoids the painful administration of radiocolloid performed in the preoperative setting. Lastly, the cost of the ICG dye technique is significantly lower than with the combined technique because additional injection time and lymphoscintigraphy are not required [18]. Given the high rates of morbidity associated with complete lymphadenectomy in this setting and that ICG dye may represent a superior SLN detection technique compared to other mapping methods, further investigation of ICG and other fluorescent dyes is merited.…”

“…Initial studies in open surgery reported poor overall detection rates of just over 75% [11]. However, laparoscopic techniques with ICG have proven more successful in gynecologic cancer [14,15,18–20]. Several studies evaluating ICG for SLN mapping in endometrial cancer also included cervical cancer cases in their publications [18,19].…”