Sentinel lymph node mapping with indocyanine green compared to blue dye tracer in gynecologic malignancies—A single center experience of 218 patients

Abstract

Background and Objectives To compare the detection rates of sentinel lymph nodes after converting the tracer technique from blue dye to indocyanine green (ICG). Methods Patients with uterine or cervical cancer were enrolled for sentinel lymph node (SLN) dissection. A total of 109 consecutive patients were analyzed and compared to a historical cohort of 109 consecutive patients with the sentinel blue dye technique. SLNs were analyzed by ultrastaging. Results The bilateral mapping rate of sentinel nodes was significantly higher with the ICG (78%; n = 85) compared to the blue dye tracer (61%; n = 67; p = .006). Neither the mean number of SLN nor the rate of low volume metastases showed significant differences between both cohorts. In the subgroup of endometrial cancer patients, the number of systematic lymph node dissection (LND) was significantly lower in the ICG cohort compared to the blue dye cohort (9% vs. 28%, p = .001). Conclusions ICG improved the detection rate of pelvic SLN compared to blue dye and may be considered as the superior technique. In clinical practice, the rate of systematic LND further decreased after incorporating SLN mapping with ICG. Reliable safety data are still pending.

The Feasibility of Sentinel Lymph-Node, Mapped with Indocyanine Green, Biopsy in Endometrial Cancer Patients: A Prospective Study

“…The most common anatomical sites were the external iliac (45.8% on the right and 46.6% on the left) and obturator regions (20.9% and 25.6%, respectively). These results were consistent with those reported in the literature, where the rate of external iliac site SL was 32-59.3%, and obturator region was 18-25% [10,[17][18][19].…”

“…The result of our study showed the overall SL detection rate of 88.8%, while bilateral detection rate was 68.2%. According to published data, the reported overall detection rate varied from 86% to 97.4%; however, bilateral detection rates were usually lower, and varied from 52% to 96% [5][6][7][8][9][10][11][17][18][19]. These results came from the trials where both robotic and laparoscopic approaches have been used.…”

“…These results came from the trials where both robotic and laparoscopic approaches have been used. In the studies where only laparoscopic surgery was performed, the overall detection rate varied from 95.5% to 97.4%, while bilateral detection rates were 76.4-88% [10,[17][18][19]. However, compared to our practice, most of these studies used different methodology for ICG dye dilution and injection.…”

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

“…A randomized non-inferiority trial of 180 patients with uterine and cervical cancer showed that, ICG detected 97% of the total lymph nodes dissected whereas blue dye identified only 47% ( 38 ). Recent research from Germany compared ICG with blue dye in EC and cervical cancer, as a result, ICG improved the DR (78% vs. 61%, p=0.006) and therefore decreased the LAD rate from 28% to 9% (p=0.001) when mapping failure occurs ( 39 ). However, the method relies on near-infrared device ( 40 ).…”

Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors

“…In gynecological tumors, a single-center cohort of 218 patients found that indocyanine green (ICG) increased the detection rate of pelvic SLNs compared with blue dye ( 22 ). For detection with 99mTc dye, lymph nodes must emit radiation that exceeds a multiple of the preset background radiation intensity to be detected.…”