Near-infrared Fluorescence-guided Sentinel Node Mapping of the Ovary With Indocyanine Green in a Minimally Invasive Setting: A Feasible Study

Buda, Alessandro; Passoni, P.; Corrado, Giacomo; Bussi, Beatrice; Cutillo, Giuseppe; Magni, Sonia; Vizza, Enrico

doi:10.1016/j.jmig.2016.09.006

Cited by 44 publications

(62 citation statements)

References 25 publications

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“…Near‐infrared fluorescence imaging (NIR‐FI)‐guided surgery using indocyanine green (ICG), a non‐specific fluorophore, has been used as a new tool for sentinel lymph node (SLN) detection in various gynecological (breast, endometrium, cervix, ovary), digestive (colon, stomach), skin, and lung cancers . More recently, it has been reported that ex vivo ICG‐FI is able to detect metastatic LNs of colorectal and head and neck cancer origin .…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5]11,12 Near-infrared fluorescence imaging (NIR-FI)-guided surgery using indocyanine green (ICG), a non-specific fluorophore, has been used as a new tool for sentinel lymph node (SLN) detection in various gynecological (breast, endometrium, cervix, ovary), digestive (colon, stomach), skin, and lung cancers. [13][14][15][16][17][18] More recently, it has been reported that ex vivo ICG-FI is able to detect metastatic LNs of colorectal and head and neck cancer origin. 19,20 Using ex vivo ICG-FI, malignant LNs are more fluorescent than benign LNs, suggesting that ICG-FI could represent a potential new imaging technique for the detection of metastatic LNs.…”

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confidence: 99%

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Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

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Veys

Galdón

et al. 2018

Journal of Surgical Oncology

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Background and objectives The aim of this study was to evaluate the role of indocyanine green (ICG) fluorescence imaging (FI) for the ex vivo detection of metastatic lymph nodes (LNs) in advanced stage ovarian cancer (AOC). Methods Paraffin‐embedded LNs from patients included in a previous ICG‐FI study (Protocol NCT01834469) were further assessed for fluorescence. Intravenous injection of ICG was delivered intraoperatively. Tumor‐to‐background ratios (TBRs) were calculated. Results A total of 675 LNs from 19 patients were analyzed. The mean LN number per patient was 29.3 (median: 24; range 2‐77). Seventy‐three LNs were malignant (10.8%), 602 were benign (89.2%). The mean TBR of all LNs was 1.5 (SD 0.8). With a cut‐off TBR of 1.3, the sensitivity, specificity, positive predictive, and negative predictive values of ICG‐FI for retroperitoneal LNs were 80%, 41%, 2.8%, and 99%, respectively. On univariate analysis, only the fluorescence ratio (TBR ≥ 1.3) was correlated with malignancy at pathology (P = 0.03). No predictive factors of pathological LN status were found on multivariate analysis. Conclusions Ex vivo ICG‐FI of retroperitoneal LNs in AOC had good sensitivity but poor specificity. However, its high negative predictive value could make it an appropriate complementary tool to focus pathological analysis on fluorescent LNs.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

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Veys

Galdón

et al. 2018

Journal of Surgical Oncology

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“…Many studies have evaluated the feasibility of detecting SLNs by injecting tracer(s) into the mesovarium and/or ovarian ligaments. Tracer injection prior to tumor resection and examination by frozen sections resulted in very high detection rates (87.5-100%) of at least one SLN (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . The present study showed that injection of tracer into the remains of both ovarian ligaments after resection of the pathological adnex resulted in a low rate of SLN detection (3 out of 11 patients, 27%; CI 10-53%).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have described the feasibility of the SLN technique in patients with early-stage EOC (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . Most recent studies utilized a method in which a tracer is injected into the ovarian ligaments prior to tumor resection, with nearly all of these studies reporting very high detection rates (71-100%…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection?

Laven

Kruitwagen

Zusterzeel³

et al. 2020

Preprint

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Objective: Sentinel lymph node (SLN) detection in ovarian cancer is feasible when tracers are injected before the pathological ovary is resected. This study aims to investigate whether the SLN identification is also feasible in patients whose ovarian tumor has already been resected with injection of the tracer into the ovarian ligaments stumps, i.e. in the event that a frozen section confirms malignancy. Methods: Patients who underwent laparotomy with frozen section confirming an ovarian malignancy, and those who underwent a second staging laparotomy after prior resection of a malignant ovarian mass, were included. Blue dye and a radioactive isotope were injected in the stumps of the ligamentum ovarium proprium and the ligamentum infundibulo-pelvicum. After an interval of at least 15-minutes, the sentinel node(s) were identified using either the gamma-probe and / or blue dye.Results: A total of 11 patients were included in the study, the sentinel node (SLN) procedure was completed in all 11 patients. At least one SLN was identified in 3 patients, resulting in a rather low detection rate of 27,3%. Conclusion: In this study we showed that SLN procedure after (previous) resection of the tumor seems inferior to detect sentinel nodes when compared to injection of the tracer in the ovarian ligaments before tumor resection.Trial registration on clinical trials: NCT02540551 https://clinicaltrials.gov/ct2/show/NCT02540551

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“…ICG achieves greater diffusion; better visualisation; greater bilateral detection, which translates into a lower risk of lymphadenectomy (61% with MB vs. 39% with ICG; p < 0.001 [63]); a shorter surgical time and long-term financial savings and can obviate the need for an injection of radiotracer [68]. It was initially stated that ICG represented an increase in the number of resected SLNs, a finding that became standard with experience in the technique [69]. Therefore, considering its good toxicity profile, its ease of use and high effectiveness, ICG is the current tracer of choice [70].…”

Section: Indocyanine Greenmentioning

confidence: 99%

Role of Sentinel Node Biopsy in Endometrial Cancer

Noval¹

2020

Current Cancer Treatment

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Lymphadenectomy, for early stages of endometrial cancer (EC), provides a low detection rate of lymphatic metastasis, without having demonstrated a therapeutic effect; so that the collection and histological analysis of the sentinel lymph node (SLN) might be an alternative to lymphadenectomy. The contribution of SLN to surgical staging represents a change in the paradigm of lymphadenectomy in EC, being an intermediate approach between not assessing the condition of the lymph nodes and complete pelvic and paraaortic dissection. Accurate identification of the main uterine drainage pathway increases the likelihood of detecting metastases during lymphatic mapping. In addition, pathological assessment by the ultrastaging of the SLN is the most important advance in the SLN biopsy (SLNB) technique. The application of the SLNB presumes a decrease in surgical and long-term morbidity, with an increase in the detection of lymphatic metastasis, mainly at the expense of detecting low tumour volume, selecting the group of patients that would benefit from a modification in adjuvant therapy. The SLNB can be established as an oncologically safe and effective method in the surgical staging of early-stage EC. Prospective studies are required to determine optimal behaviour and prognosis in the detection of low-volume metastases.Keywords: endometrial cancer, lymphatic mapping, predictive value of tests, sentinel lymph node biopsy, ultrastaging This information, provided by SLN, will change the therapeutic approach, with a potential benefit in the prognosis, both in survival and quality of life [6]. Detection methodTheoretically, the ideal method for studying SLN in EC should meet the following requirements:1. Cause the least amount of patient discomfort possible, be easy to perform and be reproducible.2. Be a preoperative procedure that enables planning of the surgical approach according to the anatomical location of the SLN.3. Enable a laparoscopic approach according to the concept of minimally invasive surgery.4. Enable the detection of SLN without complete dissection of the retroperitoneal space.5. Obtain a lymphatic map representative of the tumour drainage or, at least, of the uterine body drainage [7]. Lymphatic drainage of the uterusUnlike superficial tumours, such as melanoma, the physiology of lymphatic drainage in deeper/visceral tumours is not well established [8]. Uterine drainage, as well as being bilateral, is therefore complex [9]. Anatomically, three segments of uterine lymphatic drainage have been established:1. The lower uterine segment drains from the paracervix to the parametrium and to the broad ligament, passing by the obturator, internal iliac and interiliac lymph node chains.2. The middle third of the uterus drains the round ligament and the external iliac lymph node chain.3. The upper uterine segment drains through the infundibular pelvic ligament, uterine-ovarian plexus and gonadal vessels towards the common iliac lymph node chain, presacral lymph nodes and paraaortic lymph nodes [10].Physiologically, there a...

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Near-infrared Fluorescence-guided Sentinel Node Mapping of the Ovary With Indocyanine Green in a Minimally Invasive Setting: A Feasible Study

Cited by 44 publications

References 25 publications

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection?

Role of Sentinel Node Biopsy in Endometrial Cancer

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