The efficiency of a combined injection technique for sentinel lymph node mapping in intermediate‐high‐risk endometrial cancer

Wang, Qin; Wang, Bo; Wang, Lulu; Yu, Xue; Shan, Weiwei; Luo, Xuezhen; Wang, Chao; Chen, Xiaojun

doi:10.1002/jso.26666

Cited by 6 publications

(10 citation statements)

References 24 publications

(46 reference statements)

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“…Several reports exist on the application of sentinel node mapping, mainly by using ICG, for identifying para-aortic SLNs (PASLNs) in endometrial cancer ( 18 – 24 ). The detection rate of PASLNs in these studies varies between 14% and 86%, and one report differentiates between lower and upper PASLNs ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Mainly, robotically assisted fluorescence imaging has been used recently to identify pelvic SLNs (PESLNs). Several reports exist on its application for identifying para-aortic SLNs (PASLNs) in endometrial cancer ( 18 – 24 ). The detection rate of PASLNs in these studies, mainly after cervical injection of indocyanine green (ICG), varies between 14% and 86%, and one report differentiates between lower and upper PASLNs ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Robotic Staging of Cervical Cancer With Simultaneous Detection of Primary Pelvic and Secondary Para-Aortic Sentinel Lymph Nodes: Reproducibility in a First Case Series

et al. 2022

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ObjectiveDiscrepancies exist among international guidelines on the surgical staging of para-aortic lymph nodes in locally advanced cervical cancer (LACC), varying from considering a para-aortic lymph node dissection, at least up to the inferior mesenteric artery, to a complete para-aortic lymph node dissection. In this study, we aim to assess the reproducibility of our recently reported robotic technique using indocyanine green for identifying besides primary pelvic sentinel lymph nodes (SLNs), secondary para-aortic SLNs in a first case-cohort of cervical cancer patients.MethodsA retrospective case series of LACC patients with/without suspicious pelvic lymph nodes (LNs) on imaging (including two patients with an additional suspicious para-aortic LN) is reported. All patients underwent a robotic pelvic SLN and para-aortic sentinel/nonsentinel LN dissection using the da Vinci Xi platform. Indocyanine green was used as a fluorescent tracer, at a concentration of 1.9 mg/mL, and injected as 0.5 mL in each quadrant of the cervix.ResultsIn a total of 10 cases, primary pelvic SLNs (90% bilateral) with subsequent secondary para-aortic SLNs were identified in all cases. Lower para-aortic SLNs were present in all cases, and upper para-aortic SLNs were found in 9 out of 10 cases. The mean age of the cervical cancer patients was 49.8 years (SD ± 6.89), and the mean body mass index (BMI; kg/m2) was 23.96 (SD ± 4.60). The median total operative time was 105.5 min (range: 89–141 min). The mean numbers of primary pelvic SLNs and secondary lower and upper para-aortic SLNs were 3.10 (SD ± 1.10), 2.90 (SD ± 0.74), and 2.30 (SD ± 1.57), respectively. The median number of total para-aortic LNs (PALNs) dissected per patient was 11.5. Six patients had positive primary pelvic SLNs, and two had secondary positive para-aortic SLNs. The nonsentinel para-aortic LNs were negative in all cases. There were no intra- or postoperative complications.ConclusionOur preliminary experience demonstrates the reproducibility of identifying, besides primary pelvic SLNs, secondary lower and upper para-aortic SLNs during robotic staging in LACC. A surgical approach limiting a complete para-aortic LN dissection could reduce the potential risks and morbidity associated with this procedure. To determine the sensitivity and negative predictive value of this new surgical approach, and whether the lower para-aortic SLNs under the inferior mesenteric artery are representative of the whole para-aortic region, large prospective observational studies are needed in LACC and/or those with suspicious pelvic LNs but apparent normal para-aortic LNs on imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic Staging of Cervical Cancer With Simultaneous Detection of Primary Pelvic and Secondary Para-Aortic Sentinel Lymph Nodes: Reproducibility in a First Case Series

et al. 2022

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“…Most of those studies focused on investigating different tracers and different site of injection. Below are described the finding of the most representative studies on these issues [ 35 39 40 41 42 ]. Over the last decade, several tracers have been adopted for the identification of sentinel node during mapping procedures [ 35 39 40 41 42 ].…”

Section: Body Of Evidencementioning

confidence: 99%

“…Below are described the finding of the most representative studies on these issues [ 35 39 40 41 42 ]. Over the last decade, several tracers have been adopted for the identification of sentinel node during mapping procedures [ 35 39 40 41 42 ]. Historically, radioisotope and blue dye were used for sentinel node mapping procedures [ 35 ].…”

Section: Body Of Evidencementioning

confidence: 99%

“…However, a meta-regression on various studies showed that sensitivities are similar between various tracers and combination of tracers [ 35 ]. Another topic deserving attention is the most appropriate site of tracers’ injection [ 18 33 42 43 ]. Cervical injection (at 3 and 9 o’clock) is the most used injection site because of the high reproducibility of the procedure.…”

Section: Body Of Evidencementioning

confidence: 99%

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Sentinel node mapping in endometrial cancer

Bogani,

Giannini,

Vizza

et al. 2024

J Gynecol Oncol

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Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in endometrial cancer is controversial. Nodal status provides useful prognostic data, and allows to tailor the need of postoperative treatments. However, two independent randomized trials showed that the execution of (pelvic) lymphadenectomy increases the risk of having surgery-related complication without improving patients’ outcomes. Sentinel node mapping aims to achieve data regarding nodal status without increasing morbidity. Sentinel node mapping is the removal of first (clinically negative) lymph nodes draining the uterus. Several studies suggested that sentinel node mapping is not inferior to lymphadenectomy in identifying patients with nodal disease. More importantly, thorough ultrastaging sentinel node mapping allows the detection of low volume disease (micrometastases and isolated tumor cells), that are not always detectable via conventional pathological examination. Therefore, the adoption of sentinel node mapping guarantees a higher identification of patients with nodal disease than lymphadenectomy. Further evidence is needed to assess the value of various adjuvant strategies in patients with low volume disease and to tailor those treatments also on the basis of the molecular and genomic characterization of endometrial tumors.

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Robotic para-aortic sentinel lymph node mapping in endometrial, cervical, and ovarian cancer

Trappen

2023

Best Practice & Research Clinical Obstetrics & Gynaecol

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The efficiency of a combined injection technique for sentinel lymph node mapping in intermediate‐high‐risk endometrial cancer

Cited by 6 publications

References 24 publications

Robotic Staging of Cervical Cancer With Simultaneous Detection of Primary Pelvic and Secondary Para-Aortic Sentinel Lymph Nodes: Reproducibility in a First Case Series

Robotic Staging of Cervical Cancer With Simultaneous Detection of Primary Pelvic and Secondary Para-Aortic Sentinel Lymph Nodes: Reproducibility in a First Case Series

Sentinel node mapping in endometrial cancer

Robotic para-aortic sentinel lymph node mapping in endometrial, cervical, and ovarian cancer

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