The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

Burg, L; Verheijen, Shenna; Bekkers, Ruud L.M.; IntHout, Joanna; Holloway, Robert W.; Taşkın, Salih; Ferguson, Sarah E.; Yu, Xue; Ditto, Antonino; Baiocchi, Glauco; Papadia, Andrea; Bogani, Giorgio; Buda, Alessandro; Kruitwagen, Roy F.P.M.; Zusterzeel, Petra L.M.

doi:10.3802/jgo.2022.33.e66

Cited by 18 publications

(17 citation statements)

References 41 publications

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“…Thus, only one patient who received an injection of ICG presented a true false‐negative result: a 58‐year‐old woman with grade 2 endometrioid cancer was diagnosed with positive lymphovascular space invasion and deep myometrial involvement. As reported before, the sensitivity of SLN mapping with ICG ranged from 77.8% to 100%, and the NPV ranged from 96.6% to 100% 25,32,40,41 . The NPV of ICG in our study was comparable, whereas the sensitivity was relatively low, which may be the result of the lack of performance of the ultrastaging procedure.…”

Section: Discussionsupporting

confidence: 74%

Comparing carbon nanoparticles and indocyanine green for sentinel lymph node mapping in endometrial cancer: A randomized‐controlled single‐center trial

Liang

Deng

et al. 2023

Journal of Surgical Oncology

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Background and Objectives: To compare the feasibility and diagnostic value of sentinel lymph node (SLN) mapping with carbon nanoparticles (CNPs) and indocyanine green (ICG) in endometrial cancer (EC).Methods: This was a single-center, open-label, randomized controlled trial. Between August 1, 2020 and April 30, 2022, patients with early-stage EC were assessed for enrollment. All patients underwent SLN mapping with ICG or CNPs ± pelvic and/or para-aortic lymphadenectomy. The detection rate (DR), its impact factors, the sensitivity and the negative predictive value (NPV) of SLN mapping were analyzed.Results: In total, 206 patients, with 103 per group, were included. The overall and bilateral DRs of the two groups were comparable without significant differences.There was no difference regarding the distribution of mapped SLNs. The sensitivity was 66.7% for both groups, and the NPVs were not significantly different.Furthermore, the sensitivity and NPV reached 100% when calculated either per hemipelvis or only in patients with bilateral SLN detection.Conclusions: SLN mapping by CNPs in EC is feasible with high DRs and diagnostic accuracy compared with ICG. CNPs might be an alternative to ICG for SLN mapping when near-infrared imaging equipment is lacking, especially in stage IA patients.carbon nanoparticles, endometrial cancer, indocyanine green, sentinel lymph node mapping | INTRODUCTIONEndometrial cancer (EC) is the most common gynecologic malignancy in the United States, and its rapidly increasing incidence rate ranks second in China. 1,2 The metastatic status of regional lymph nodes is considered an independent prognostic factor for EC. Thus, the evaluation of lymph nodes should be completed precisely, as this is essential for tumor staging and clinical decisions on the selection of adjuvant therapy. For preoperatively presumed early-stage EC patients, comprehensive lymphadenectomy (LAD) is often adopted

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Section: Discussionsupporting

confidence: 74%

Comparing carbon nanoparticles and indocyanine green for sentinel lymph node mapping in endometrial cancer: A randomized‐controlled single‐center trial

Liang

Deng

et al. 2023

Journal of Surgical Oncology

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“…It has been suggested that ICG provides better tissue penetration than the other tracers used, as it may be suggested by our findings, and also makes identification easier for the surgeon [ 33 , 34 ]. In addition, comparing our results with a recent meta-analysis [ 27 ] of patients with low- and intermediate-risk endometrial cancer that used ICG as an SLN tracer, we achieved a higher bilateral rate of SLN mapping with ICG with similar overall detection rates, proving the ICG is a more suitable tracer option. Although this meta-analysis only included the ICG data of the studies included, several of them used multiple tracers and small populations of patients for ICG were used.…”

Section: Discussionsupporting

confidence: 54%

“…Few papers have been published comparing ICG with Tc99m + ICG, but in a study [ 26 ] that compared Tc99m alone vs. ICG + Tc99m, the total bilateral detection rate was 72.1%, without significant differences between ICG as a single tracer and Tc99m + ICG (75% vs. 87.3%, respectively; p = 0.1). In a recent meta-analysis [ 27 ], researchers showed that SLN mapping with ICG has a high overall detection rate of 95.6% (95% CI = 92.4–97.9%) and a bilateral detection rate of 76.5% (95% CI = 68.1–84.0) in low- and intermediate-risk endometrial cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Personalized Sentinel Node Mapping in Endometrial Cancer by the Indocyanine Green Implementation as Single Tracer: A Case Control Study

Quevedo

Cristóbal

Gracia

et al. 2023

JPM

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The main objective was to analyze the rate of bilateral sentinel lymph node (SLN) detection in endometrial cancer using indocyanine green (ICG) as a unique tracer compared to Technetium99 + ICG. As secondary objectives, we analyzed the drainage pattern and factors that might affect the oncological outcomes. A case-control ambispective study was carried out on consecutive patients at our center. Data on the SLN biopsy with ICG collected prospectively were compared to retrospective data on the use of a double-tracer technique including Technetium99 + ICG. In total, 194 patients were enrolled and assigned to both groups, in which the group with both tracers (controls) included 107 (54.9%) patients and the ICG-alone group (cases) included 87 (45.1%) patients. The rate of bilateral drainage was significantly higher in the ICG group (98.9% vs. 89.7%; p = 0.013). The median number of nodes retrieved was higher in the control group (three vs. two nodes; p < 0.01). We did not find survival differences associated with the tracer used (p = 0.85). We showed significant differences in terms of disease-free survival regarding the SLN location (p < 0.01), and obturator fossa retrieved nodes showed better prognosis compared to external iliac. The use of ICG as a single tracer for SLN detection in endometrial cancer patients seemed to obtain higher rates of bilateral detection with similar oncological outcomes.

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“…Sentinel lymph node biopsy has been validated as a standard of care in breast cancer, melanoma and gynaecological malignancies [1][2][3]. With regards to endometrial and cervical cancer, the use of ICG uorescence imaging has been extensively investigated and has proven to be a safe, time-e cient and reliable method compared to standard tracers such as the Patent blue and technetium 99m [4].…”

Section: Introductionmentioning

confidence: 99%

New Clinical Application of Indocyanine Green in Fluorescence- Guided Laparoscopic Lymph-node Biopsy in Case of Lymphoma. Preliminary Results on a Case Series

Casaccia

Ibatici²,

Ballerini

et al. 2023

Preprint

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Background Indocyanine Green (ICG) fluorescence-guided surgery is widely used for intraoperative visualization of lymphatic structures. To date, there are no reports indicating this dye being used in lymph node biopsies for suspected or relapsed lymphoma.Methods Between October 2021 and June 2022, 12 patients underwent a fluorescence-guided laparoscopic lymph node biopsy (FGLLB) using ICG. The following was retrospectively evaluated: the dosage of ICG, the injection site, the number of patients where fluorescence was obtained after ICG administration, and additionally, the parameters indicating the outcome of the surgical procedure.Results The median duration of the surgery was 90 minutes. A laparotomy conversion was required in one case due to bleeding. Fluorescence was obtained in 10/12 (83.3%) patients by means of subcutaneous/perilesional injection in six of the patients, and intravenously in the other four. Hospitalization had a mean duration of three days. There were no major postoperative complications. FGLLB was used in seven patients to follow lymphoproliferative disease progression, and in five patients to establish a diagnosis. In all cases, FGLLB provided the information necessary for the correct diagnosis.Conclusions Fluorescence with ICG offers a simple and safe method for detecting pathological lymph nodes. FGLLB in suspected intra-abdominal lymphoma can largely benefit from this new opportunity which has not yet been tested to date. Further studies with large case series are needed to confirm its efficacy.

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The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis

Cited by 18 publications

References 41 publications

Comparing carbon nanoparticles and indocyanine green for sentinel lymph node mapping in endometrial cancer: A randomized‐controlled single‐center trial

Comparing carbon nanoparticles and indocyanine green for sentinel lymph node mapping in endometrial cancer: A randomized‐controlled single‐center trial

Personalized Sentinel Node Mapping in Endometrial Cancer by the Indocyanine Green Implementation as Single Tracer: A Case Control Study

New Clinical Application of Indocyanine Green in Fluorescence- Guided Laparoscopic Lymph-node Biopsy in Case of Lymphoma. Preliminary Results on a Case Series

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