Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer

Abstract

Objective Our study objective was to determine feasibility and mapping rates using indocyanine green (ICG) for sentinel lymph node (SLN) mapping in early-stage cervical cancer. Methods We performed a retrospective review of all women who underwent SLN mapping with ICG during primary surgical management of early-stage cervical cancer by robotic-assisted radical hysterectomy (RA-RH) or fertility-sparing surgery. Patients were treated at two high-volume centers from 10/2012 to 02/2016. Completion pelvic lymphadenectomy was performed after SLN biopsy; additionally, removal of clinically enlarged/suspicious nodes was part of the SLN treatment algorithm. Results Thirty women with a median age of 42.5 and BMI of 26.5 were included. Most (90%) had stage IB disease, and 67% had squamous histology. RA-RH was performed in 86.7% of cases. One patient underwent fertility-sparing surgery. Median cervical tumor size was 2.0 cm. At least one SLN was detected in all cases (100%), with bilateral mapping achieved in 87%. SLN detection was not impacted by tumor size and was most commonly identified in the hypogastric (40.3%), obturator (26.0%), and external iliac (20.8%) regions. Five cases of lymphatic metastasis were identified (16.7%): three in clinically enlarged SLNs, one in a clinically enlarged non-SLN, and one case with cytokeratin positive cells in an SLN. All metastatic disease would have been detected even if full lymphadenectomy had been omitted from our treatment algorithm, Conclusions SLN mapping with ICG is feasible and results in high detection rates in women with early-stage cervical cancer. Prospective studies are needed to determine if SLN mapping can replace lymphadenectomy in this setting.

New Developments in Minimally Invasive Gynecologic Oncology Surgery

“…Five patients were found to have metastatic disease all of which were detected using the SLN protocol. This small study demonstrated promising results for SLN mapping to potentially replace full lymphadenectomy 74 (Table 3). More studies on the clinical utility of SLN mapping in our field are eagerly anticipated.…”

Sentinel lymphadenectomy in cervical cancer using near infrared fluorescence from indocyanine green combined with technetium‐99m‐nanocolloid

“…The bilateral ICG detection rate was significantly higher than in the control group (95.5% vs. 61%) . Beavis et al reported data from 30 patients with early‐stage cervical cancer in which a robotic‐assisted radical hysterectomy or fertility‐sparing surgery and pelvic sentinel lymph node excision with ICG alone was carried out . They found a unilateral and bilateral mapping rate of 100% and 87%.…”

“…Different studies showed the ability of ICG to identify sentinel lymph nodes in cervical cancer [9,10,[22][23][24][25][26]. These studies were carried out either by conventional laparoscopic or robotic-assisted approach.…”

Minimally Invasive Techniques for Treating Gynecologic Malignancies

“…Fader briefly reviewed the surgical technique for identifying the SLN through the injection of isosulfan blue or indocyanine green dyes. 8 “You can see these gorgeous channels coursing through the retroperitoneum to identify the lymph node,” she noted. However, she added, SLN mapping appears to be better with the green dye, particularly in obese patients.…”