Learning curve for sentinel lymph node mapping in gynecologic malignancies

Kim, S.; Ryu, Ki Jin; Min, Kyung Jin; Lee, Sanghoon; Jung, Un Suk; Song, Jae Yun; Lee, Jae Kwan; Lee, Nak Woo

doi:10.1002/jso.25853

Cited by 29 publications

(14 citation statements)

References 21 publications

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“…In breast cancer, a minimum of 20 SLN procedures were required to be proficient in SLN algorithm. 29 Kim et al 30 Several studies have revealed that SLN mapping could help to detect metastases beyond the region of routine pelvic lymphadenectomy (ie, unusual localizations). 15,31 These unusual localizations include the para-aortic region, common iliac region, parametrial region and presarcal region.…”

Section: Discussionmentioning

confidence: 99%

Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles

Wang

Zhao

Yuan

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Carbon nanoparticles (CNPs) has been widely confirmed the efficiency in sentinel lymph node (SLN) mapping for various solid tumors. This study aims to explore the feasibility and effectiveness of CNPs during laparoscopic surgery for cervical cancer. Methods We analyzed 45 women with stage IB1‐IIA1 cervical cancer who underwent SLN mapping using CNPs during laparoscopic surgery. The effectiveness of CNPs was evaluated by the detection rate and accuracy parameters. Factors associated with SLN laterality and SLNs localizations were analyzed. Results The overall and bilateral detection rate was 93.3% (42/45) and 60.0% (27/45), respectively. Elevated body mass index was associated with decreased bilateral detection rate (P = .015). A total of 225 SLNs were harvested, with a mean number of 5.0 ± 3.6. A total of 81.3% of SLNs were in expected localizations including external iliac (39.1%), internal iliac (25.8%), and obturator (16.4%) regions, while 18.7% in unusual localizations including common iliac (10.7%), parametrial (7.6%), and presarcal (0.4%) regions. None positive lymph node was found in non‐SLNs with a false‐negative rate of 0%. Conclusion Laparoscopic SLN mapping with CNPs appears to be simple and efficient for patients with early‐stage cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles

Wang

Zhao

Yuan

et al. 2020

Journal of Surgical Oncology

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“… 45 This is in line with the recently reported learning curve of at least 27 cases for SLN mapping with ICG. 46 A learning curve effect is further substantiated by Balaya et al, who showed that centers with less than five patients per year had significantly lower bilateral mapping rates than the so‐called “high skilled centers” (≥5 patients per year). 43 The learning curve of the SLN procedure—irrespective of the tracer used—may have contributed to the variation in reported detection rates of 99m Tc with blue dye.…”

Section: Discussionmentioning

confidence: 96%

Indocyanine green versus technetium‐99m with blue dye for sentinel lymph node detection in early‐stage cervical cancer: A systematic review and meta‐analysis

et al. 2021

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Background: The fluorescent dye indocyanine green (ICG) has emerged as a promising tracer for intraoperative detection of sentinel lymph nodes (SLNs) in early-stage cervical cancer. Although researchers suggest the SLN detection of ICG is equal to the more conventional combined approach of a radiotracer and blue dye, no consensus has been reached. Aims:We aimed to assess the differences in overall and bilateral SLN detection rates with ICG versus the combined approach, the radiotracer technetium-99m ( 99m Tc) with blue dye. Methods and Results:We searched MEDLINE, Embase, and the Cochrane Library from inception to January 1, 2020 and included studies reporting on a comparison of SLN detection with ICG versus 99m Tc with blue dye in early-stage cervical cancer.The overall and bilateral detection rates were pooled with random-effects metaanalyses.From 118 studies retrieved seven studies (one cross-sectional; six retrospective cohorts) were included, encompassing 589 patients. No significant differences were found in the pooled overall SLN detection rate of ICG versus 99m Tc with blue dye. Meta-analyses of all studies showed ICG to result in a higher bilateral SLN detection rate than 99m Tc with blue dye; 90.3% (95%CI, 79.8-100.0%) with ICG versus 73.5% (95%CI, 66.4-80.6%) with 99mTc with blue dye. This resulted in a significant and clinically relevant risk difference of 16.6% (95%CI, 5.3-28.0%). With sensitivity analysis, the risk difference of the bilateral detection rate maintained in favor of ICG but was no longer significant (13.2%, 95%CI −0.8-27.3%).Conclusion: ICG appears to provide higher bilateral SLN detection rates compared to 99m Tc with blue dye in patients with early-stage cervical cancer. However, in adherence with the Grading of Recommendations, Assessment, Development, and

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“…On the other hand, it is important to assess the learning curve, considered an independent factor that can influence the quality of the technique. This has been estimated at a total of 20-30 surgeries, improving with the accumulation of cases per surgeon, although it seems to be independent of experience in minimally invasive surgery [19] . In our study the learning curve occurred in 10 surgeries, since from patient number 11 onwards bilateral DR improved considerably.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study for the Validation of Sentinel Lymph Node Biopsy with Indocyanine Green Fluorescence Method in Early Endometrial Cancer at Fundacion Jimenez Diaz University Hospital

Villayzán¹,

Fuente²,

Trigo³

et al. 2021

JSO

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Background: Sentinel Lymph Node Biopsy is a technique developed to predict lymphatic involvement in patients with early endometrial cancer, decreasing the morbimortality associated with routine systematic lymphadenectomy and improving quality of life. Main Objective: To determine the detection rate and negative predictive value of the Sentinel Lymph Node Biopsy by Immunofluorescence in patients with early endometrial cancer. Methods: A descriptive observational study in patients with early endometrial cancer (FIGO stage I-II) for all histological types and grades, who underwent the Sentinel Lymph Node by immunofluorescence Technique, between June 2019 and March 2020 at the Fundación Jiménez Díaz University Hospital. We used indocyanine green powder for injection, with a concentration of 25 milligrams (mg). We proceeded to dissolve it in 10 cubic centimeters (cc) of distilled water to. After which, we injected 2 cc of the prepared solution into the cervix at the 3 and 9 o’clock positions at a depth of 1 centimeter. Results: Eighteen patients were included, analysing a total of 26 sentinel nodes: 24 pelvic and 2 paraortic; and a total of 273 lymph nodes (sentinel and non-sentinel nodes): 83 right pelvic, 86 left pelvic and 104 paraortic. All nodes were negative for metastasis. Global and bilateral detection rates were 77.78% and 50% respectively. The Negative Predictive Value and sensitivity were 100%. No significant difference in morbimortality was found between performing only Sentinel Lymph Node technique or systematic lymphadenectomy, but the association with quality of life was significant, with better results for those who only underwent the sentinel lymph node technique versus systematic lymphadenectomy (0% vs 77%). Conclusion: The global and bilateral detection rates of the Sentinel Lymph Node Technique by immunofluorescence were 77.78% and 50% respectively, obtaining a Negative Predictive Value and Sensitivity of 100%. Sentinel Node Biopsy is a valid technique to predict lymphatic affectation in early endometrial cancer, with lower morbimortality than systematic lymphadenectomy.

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Learning curve for sentinel lymph node mapping in gynecologic malignancies

Cited by 29 publications

References 21 publications

Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles

Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles

Indocyanine green versus technetium‐99m with blue dye for sentinel lymph node detection in early‐stage cervical cancer: A systematic review and meta‐analysis

A Pilot Study for the Validation of Sentinel Lymph Node Biopsy with Indocyanine Green Fluorescence Method in Early Endometrial Cancer at Fundacion Jimenez Diaz University Hospital

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