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. 2016 Nov;143(2):302-306.
doi: 10.1016/j.ygyno.2016.08.236. Epub 2016 Aug 12.

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

Anna L Beavis  1 , Sergio Salazar-Marioni  2 , Abdulrahman K Sinno  1 , Rebecca L Stone  1 , Amanda N Fader  1 , Antonio Santillan-Gomez  3 , Edward J Tanner 3rd  4
Affiliations

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

Anna L Beavis et al. Gynecol Oncol. 2016 Nov.

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 2.0cm. 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.

Keywords: Cervical cancer; Fluorescence imaging; Indocyanine green; Robotic hysterectomy; Sentinel lymph node.

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Conflict of interest statement

Conflict of interest

All authors confirm they have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Sentinel Lymph Node Mapping Algorithm.
See this image and copyright information in PMC

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