Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99m with blue dye versus indocyanine green fluorescent dye

Papadia, Andrea; Zapardiel, Ignacio; Bussi, Beatrice; Ghezzi, Fabio; Ceccaroni, Marcello; Ponti, Elena De; Elisei, Federica; Imboden, Sara; Noval, Begoña Díaz de la; Gasparri, Maria Luisa; Martino, Giampaolo Di; Mueller, Michael D.; Vecchione, Francesca; Dell’Orto, Federica; Buda, Alessandro

doi:10.1007/s00432-016-2297-y

Cited by 75 publications

(65 citation statements)

References 22 publications

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“…While this combination was not explored in the FILM trial, a European study addressed this in a retrospective, multi-institution review of 147 patients with blue dye combined with Tc99 compared with 195 patients who received ICG alone 28. With respect to overall detection rates, ICG did not differ significantly from the combined blue dye + Tc99 technique, with both above 96%; however, there was a significantly higher bilateral detection rate for the group in which ICG was used (84.1% vs 73.9%; p=0.007).…”

Section: Feasibility Technique Development and Variationmentioning

confidence: 99%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

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Sentinel lymph node (SLN) biopsy has been investigated as an alternative to conventional pelvic and para-aorticlymphadenectomy for the surgical staging of endometrial cancer. Clinical trials have established the accuracy of sentinel nodes in the detecting metastatic disease. Novel advancements in tracers from the historically favored blue dyes and radio labeled colloids to near infrared imaging of fluorescent dyes has improved the ability to detect sentinel nodes and increased options for surgeons. The uterine cervix has been shown to be a feasible and accurate injection site for tracer, though the potential for under-evaluation of the para-aortic nodes remains a controversy, particularly for high-risk cancers. Additionally, sentinel node evaluation provides qualitatively different information than traditional staging techniques by identifying lymph nodes outside of traditional sampling locations and through the identification of very low volume meta static disease implants, such as isolated tumor cells. It is unclear how this altered staging information should be interpreted, guide the prescription of adjuvant therapy and its impact on long term clinical outcomes such as recurrence and survival. In this review we will discuss the evidence that has supported the use of the SLN technique in the staging of endometrial cancer, the options for surgical technique and the implications of managing the results of staging pathology.

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Section: Feasibility Technique Development and Variationmentioning

confidence: 99%

Current state of sentinel lymph nodes for women with endometrial cancer

Rossi

2019

Int J Gynecol Cancer

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“…At present, the use of green indocyanine (ICG) seems to offer better results in terms of overall and bilateral detection rate [18][19][20]. But what are the reasons for the methods failure?…”

Section: Introductionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in the Treatment of Endometrial Cancer: Why We Fail? Results of a Prospective Multicenter Study on the Factors Associated with Failure of Node Mapping with Indocyanine Green

Ianieri

Puppo²,

Novelli³

et al. 2019

Gynecol Obstet Invest

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Background: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping. Objectives: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG). Methods: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG. Results: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003). Conclusions: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.

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“…Different centers have been using different doses and concentrations of ICG for SLN mapping which are typically lower than the one adopted at our institution, ranging from 0,5 to 2,5 mg/ml [2,15]. It is unlikely that the higher dose of ICG injected is responsible for the recorded allergic reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Overall ICG remains a very safe product that performs better than the other conventional tracers (such as Tc-99m and blue dyes alone or in combination) when adopted for the SLN mapping in gynecologic oncology [2][3][4][5][6]8]. Although adverse reactions resulting from an intravenous or an interstitial injection of ICG are expected to be the same, since ICG has only been approved by FDA for intravenous injection, it is crucial to inform the patients undergoing SLN mapping on its off-label use as adverse reactions may otherwise lead to unpleasant medico-legal consequences.…”

Section: Discussionmentioning

confidence: 99%

“…This allows for an easy identification of the SLN. In gynecologic oncology this tracer has proven to be at least equivalent to the combination of technetium-99m Tc-99m and blue dyes as far as detection rates goes [2][3][4][5][6]. ICG seems to perform better in obese patients and is user friendlier as it does not require a preoperative intracervical injection as is the case with Tc-99m.…”

Section: Introductionmentioning

confidence: 99%

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