Risk factors for failure of sentinel lymph node mapping using indocyanine green/near-infrared fluorescent imaging in endometrial cancer

Taşkın, Salih; Sarı, Mustafa; Altın, Duygu; Ersöz, Cevriye Cansız; Gökçe, Ali; Yüksel, Seher; Kankaya, Duygu; Ortaç, Fırat

doi:10.1007/s00404-019-05137-5

Cited by 20 publications

(27 citation statements)

References 18 publications

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“…However, the patients who failed mapping were more likely to have a macro-metastasis than in the SLN of those with successful mapping. A similar phenomenon was described in a study by Taskin et al of 101 endometrial cancer patients in which patients with stage III and IV disease had higher rates of mapping failure, though this did not reach statistical significance 2. Furthermore, they noted that over half of their SLN metastases that were not grossly enlarged had successful mapping while 21% with grossly enlarged SLNs had mapping failure.…”

Section: Discussionsupporting

confidence: 73%

“…However, limited evidence exists to explain why SLN mapping fails in endometrial cancer. Some have proposed factors such as cervical or uterine lengths, large tumors, deep myometrial invasion,2 obesity, fibroids, or bulky metastasis3 may contribute to mapping failure. It has been demonstrated in breast cancer that patients with extensive nodal involvement are more likely to fail SLN mapping,4 possibly because of tumor cells obstructing lymphatics.…”

Section: Introductionmentioning

confidence: 99%

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Robotic sentinel lymph node (SLN) mapping in endometrial cancer: SLN symmetry and implications of mapping failure

Stephens

Kennard

Fitzsimmons

et al. 2019

Int J Gynecol Cancer

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PurposeTo establish the bilateral pelvic concordance rate of the sentinel lymph node (SLN) and determine the likelihood of lymph node metastasis in cases of mapping failure.MethodsA database analysis was performed on 414 patients with clinical stage I endometrial cancer who underwent SLN mapping followed by robotic hysterectomy and completion pelvic (n=414, 100%) and aortic (n=186, 44.9%) lymphadenectomy from March 2011 to August 2016. Stage, histology, SLN sites, and surgico-pathologic findings were analyzed. The bilateral concordance rate of SLN location, successful unilateral and bilateral mapping rates, false negative rate, and non-SLN metastasis associated with mapping failure were calculated.ResultsHistologies included 354 (85.5%) endometrioid, 39 (9.4%) serous, 16 (3.9%) carcinosarcoma, 4 (1.0%) clear cell, and 1 (0.2%) undifferentiated. Final stages included 262 (63.3%) IA, 36 (8.7%) IB, 15 (3.6%) II, 6 (1.4%) IIIA, 68 (16.4%) IIIC1, and 27 (6.5%) IIIC2. Bilateral SLN mapping was successful in 355 (85.7%) patients, and 266 (74.9%) demonstrated mapping to the symmetrical lymphatic group contralaterally. The mapping failure rate was 13.5% (56/414) unilaterally and 0.7% (3/414) bilaterally. SLN locations were external iliac (69.1%), obturator (25.1%), internal iliac (2.2%), common iliac (1.9%), pre-sacral (0.9%), aortic (0.4%), parametrial (0.3%), and para-rectal (0.1%). Lymph node metastases were identified in 95 (22.9%) pelvic and 27 (6.5%) aortic nodes. 10 (16.9%) cases with mapping failure had lymph node metastasis on completion lymphadenectomy, similar to the proportion of SLNs with metastases (p=0.35). However, macro-metastases were more common in mapping failure completion lymphadenectomies than in the positive SLNs (80% vs 22.3%, p<0.001).ConclusionThe contralateral SLN location concordance rate was 75%. Most SLNs were along the medial external iliac or obturator locations. The rate of positive lymph nodes associated with SLN mapping failure was 16.9%, similar to the overall node-positive rate. The detection of pelvic node metastasis with SLN mapping failure was largely populated with macro-metastases and confirms the necessity of completion lymphadenectomy with mapping failure.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Robotic sentinel lymph node (SLN) mapping in endometrial cancer: SLN symmetry and implications of mapping failure

Stephens

Kennard

Fitzsimmons

et al. 2019

Int J Gynecol Cancer

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“…There was no clinical or histopathologic factor related to mapping rate except obesity. Surgery and retroperitoneal observation may be difficult in obese patients and previous studies reported similar results 15 16. Mapping rates were not affected by the tracers used in this study and were comparable with previously reported rates.…”

Section: Discussionsupporting

confidence: 90%

Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001)

Taşkın

Altın

Vatansever

et al. 2019

Int J Gynecol Cancer

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ObjectiveThe aim of this multicenter study was to evaluate the feasibility of sentinel lymph node (SLN) mapping in clinically uterine confined endometrial cancer.MethodsPatients who underwent primary surgery for endometrial cancer with an SLN algorithm were reviewed. Indocyanine green or blue dye was used as a tracer. SLNs and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. SLNs were ultrastaged on final pathology.Results357 eligible patients were analyzed. Median age was 59 years. Median number of resected SLNs was 2 (range 1–12) per patient. Minimal invasive and open surgeries were performed in 264 (73.9%) and 93 (26.1%) patients, respectively. Indocyanine green was used in 231 (64.7%) and blue dye in 126 (35.3%) patients. The dyes were injected into the cervix in 355 (99.4%) patients. The overall and bilateral SLN detection rates were 91.9% and 71.4%, respectively. The mapping rates using indocyanine green or blue dye were comparable (P=0.526). There were 43 (12%) patients with lymphatic metastasis. The SLN algorithm was not able to detect 3 of 43 patients who had isolated paraaortic metastasis. After SLN biopsy, complete pelvic lymphadenectomy was performed in 286 (80.1%) patients. Sensitivity and negative predictive value were both 100% for the detection of pelvic lymph node metastases. In addition, 117 (32.8%) patients underwent completion paraaortic lymphadenectomy after SLN biopsy. In these patients, sensitivity for detecting metastases to pelvic and/or paraaortic lymph nodes was 90.3% with a negative predictive value of 96.6%. The risk of non-SLN involvement in patients with macrometastatic SLNs, micrometastatic SLNs, and isolated tumor cells in SLNs were 61.2%, 14.3% and 0%, respectively.ConclusionsSLN biopsy had good accuracy in detecting lymphatic metastasis. However, one-third of cases with metastatic SLNs also had non-SLN involvement and this risk increased to two-thirds of cases with macrometastatic SLNs. The effect of leaving these nodes in situ on survival should be evaluated in further studies.

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“…A slower lymphatic drainage has also been suggested such as in breast cancer [25]. However, ICG may reverse the negative effect of obesity on SLN mapping as shown in endometrial cancer with an improvement of SLN detection with ICG compared to blue dye [9,24]. Near-infrared imaging with ICG allows deeper visualization of SLN through adipose tissue with a penetration of 1 cm.…”

Section: Discussionmentioning

confidence: 99%

“…However, bilateral SLN detection is obtained in 60% of cases only [4]. In endometrial cancer, body-mass index, type of dye injection, clinically suspicious nodes and uterine morphology may have an impact on failure for SLN mapping [8,9] but these risk-factors remain unclear in cervical cancer [10].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for failure of bilateral sentinel lymph node mapping in early-stage cervical cancer

Balaya

Bresset

Guani

et al. 2020

Gynecologic Oncology

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Risk factors for failure of sentinel lymph node mapping using indocyanine green/near-infrared fluorescent imaging in endometrial cancer

Cited by 20 publications

References 18 publications

Robotic sentinel lymph node (SLN) mapping in endometrial cancer: SLN symmetry and implications of mapping failure

Robotic sentinel lymph node (SLN) mapping in endometrial cancer: SLN symmetry and implications of mapping failure

Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001)

Risk factors for failure of bilateral sentinel lymph node mapping in early-stage cervical cancer

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