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Comparative Study
. 2016 Jul;23(7):2183-91.
doi: 10.1245/s10434-015-5022-1. Epub 2015 Dec 29.

Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m)Tc and/or Blue Dye

Alessandro Buda  1   2 , Cinzia Crivellaro  3   4 , Federica Elisei  4 , Giampaolo Di Martino  5   3 , Luca Guerra  4 , Elena De Ponti  6 , Marco Cuzzocrea  3 , Daniela Giuliani  5   3 , Federica Sina  5   3 , Sonia Magni  5   3 , Claudio Landoni  3   4   7 , Rodolfo Milani  5   3
Affiliations
Comparative Study

Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m)Tc and/or Blue Dye

Alessandro Buda et al. Ann Surg Oncol. 2016 Jul.

Abstract

Purpose: To compare the detection rate (DR) and bilateral optimal mapping (OM) of sentinel lymph nodes (SLNs) in women with endometrial and cervical cancer using indocyanine green (ICG) versus the standard technetium-99m radiocolloid ((99m)Tc) radiotracer plus methylene or isosulfan blue, or blue dye alone.

Methods: From October 2010 to May 2015, 163 women with stage I endometrial or cervical cancer (118 endometrial and 45 cervical cancer) underwent SLN mapping with (99m)Tc with blue dye, blue dye alone, or ICG. DR and bilateral OM of ICG were compared respectively with the results obtained using the standard (99m)Tc radiotracer with blue dye, or blue dye alone.

Results: SLN mapping with (99m)Tc radiotracer with blue dye was performed on 77 of 163 women, 38 with blue dye only and 48 with ICG. The overall DR of SLN mapping was 97, 89, and 100 % for (99m)Tc with blue dye, blue dye alone, and ICG, respectively. The bilateral OM rate for ICG was 85 %-significantly higher than the 58 % obtained with (99m)Tc with blue dye (p = 0.003) and the 54 % for blue dye (p = 0.001). Thirty-one women (19 %) had positive SLNs. Sensitivity and negative predictive value of SLN were 100 % for all techniques.

Conclusions: SLNs mapping using ICG demonstrated higher DR compared to other modalities. In addition, ICG was significantly superior to (99m)Tc with blue dye in terms of bilateral OM in women with early stage endometrial and cervical cancer. The higher number of bilateral OM may consequently reduce the overall number of complete lymphadenectomies, reducing the duration and additional costs of surgical treatment.

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Figures

Fig. 1
Fig. 1
SLN anatomic distribution and metastasis location in the study population. In our population, 384 SLNs were obtained by all modalities. Number of SLNs per site indicated by circles; number of positive SLNs at histology indicated by triangles. *Four SLNs were in parametrial site. SLN sentinel lymph node
Fig. 2
Fig. 2
Typical location of sentinel lymph node (SLN). a White light view of a SLN (asterisk) located in the ventral medial aspect of the external iliac artery (EIA). b The appearance of the SLN with the ICG real-time florescence Storz SPIES HD for laparoscopic platform. EIA external iliac artery, IIA internal iliac artery, EIV external iliac vein, U ureter, LP lateral parametrium
See this image and copyright information in PMC

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