Anatomic Asymmetry in Sentinel Lymph Node Detection in Endometrial Cancer.

Published on Aug 1, 2021in Journal of Minimally Invasive Gynecology3.107
· DOI :10.1016/J.JMIG.2020.12.029
Ori Tal2
Estimated H-index: 2
(Wolfson Medical Center),
Ehud Grinstein7
Estimated H-index: 7
(Wolfson Medical Center)
+ 6 AuthorsTally Levy21
Estimated H-index: 21
(Wolfson Medical Center)
Abstract Study Objective To determine whether the concomitant use of indocyanine green (ICG) with Tc-99m filtered sulfur colloid (Tc99m-FSC) improves bilateral sentinel lymph node (SLN) detection rate in endometrial cancer (EC), and whether anatomic concordance of pelvic lymph nodes exists and can be used to predict SLN location in cases of unilateral mapping failure. Design A retrospective cohort study. Setting A tertiary academic medical center in Holon, Israel. Patients Patients diagnosed with EC, who underwent SLN mapping with Tc99m-FSC, ICG or both, at our center, between 2014-2019. Interventions 111 patients were included in the study. SLN mapping using Tc99m-FSC was performed in 101 (91.9%) patients and ICG injection was given to 64 (57.6%) out of whom 55 patients (49.5%) received both. We compared SLN detection rates (unilateral and bilateral) and anatomic symmetry for each method alone and for a combination of the two. Measurements and Main Results The overall detection rate for unilateral SLNs was 96.4%; 96.9% with ICG, 93.07% with gamma-probe and 98.2% by combining both methods. Total bilateral detection rate was 72.1%, with ICG performing better as a single tracer than Tc99m-FSC (75% vs. 63.4%, respectively). In 55 women in whom both tracers were used, bilateral detection rate was significantly higher compared to Tc99m-FSC alone. Symmetrical pelvic anatomical concordance of SLN was found in only 35 out of 80 patients with bilateral SLN detection (43.75%). Conclusion The combination of preoperative radioisotope injection and intraoperative ICG administration may yield the best bilateral SLN detection rate. In case of unilateral mapping failure, one cannot rely on the anatomic location of the ipsilateral SLN detected in order to harvest the complementary node, since the symmetrical concordance is poor.
Purpose To establish the bilateral pelvic concordance rate of the sentinel lymph node (SLN) and determine the likelihood of lymph node metastasis in cases of mapping failure. Methods A database analysis was performed on 414 patients with clinical stage I endometrial cancer who underwent SLN mapping followed by robotic hysterectomy and completion pelvic (n=414, 100%) and aortic (n=186, 44.9%) lymphadenectomy from March 2011 to August 2016. Stage, histology, SLN sites, and surgico-pathologic findi...
4 CitationsSource
#1Silvia Cabrera (Autonomous University of Barcelona)H-Index: 14
#2Vicente BebiaH-Index: 3
Last. Antonio Gil-Moreno (Autonomous University of Barcelona)H-Index: 32
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Introduction The low accuracy of pre-operative imaging techniques for prediction of nodal status strengthens the relevance of sentinel lymph node (SLN) biopsy in endometrial cancer, although the optimal method for its detection is still under investigation. The increasing use of indocyanine green (ICG) has aroused concern about its enhanced visualization of lymphatic channels, which could lead to a specimen that is thought to be nodal tissue not subsequently yielding a lymph node on pathologic a...
6 CitationsSource
#1Roy Kessous (BGU: Ben-Gurion University of the Negev)H-Index: 16
#2Jeffrey How (McGill University)H-Index: 11
Last. Susie Lau (McGill University)H-Index: 21
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Objective Sentinel lymph node (SLN) mapping is increasingly being used in the treatment of apparent early-stage endometrial cancer. The aim of this study was to evaluate whether three tracers (blue dye, indocyanine green (ICG), and technetium-99 (Tc99)) performed better than two (ICG and Tc99). Study Design Prospective study of all consecutive patients (n=163) diagnosed with clinical early-stage endometrial cancer from 2015 to 2017. All patients were randomly assigned to receive a mixture of ICG...
5 CitationsSource
#1Jonathan A Frost (Gloucestershire Hospitals NHS Foundation Trust)H-Index: 4
#2Katie E Webster (Royal College of Obstetricians and Gynaecologists)H-Index: 4
Last. Jo Morrison (Musgrove Park Hospital)H-Index: 10
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Background This is an update of a previous Cochrane review published in Issue 1, 2010 and updated in Issue 9, 2015. The role of lymphadenectomy in surgical management of endometrial cancer remains controversial. Lymph node metastases can be found in approximately 10% of women who before surgery are thought to have cancer confined to the womb. Removal of all pelvic and para-aortic lymph nodes (lymphadenectomy) at initial surgery has been widely advocated, and pelvic and para-aortic lymphadenectom...
234 CitationsSource
#1Jeffrey How (McGill University)H-Index: 11
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Abstract Introduction To evaluate the anatomical location of sentinel lymph nodes (SLN) following intra-operative cervical injection in endometrial cancer. Methods All consecutive patients with endometrial cancer undergoing sentinel lymph node mapping were included in this prospective study following intra-operative cervical injection of tracers. Areas of SLN detection distribution were mapped. Results Among 436 patients undergoing SLN mapping, there were 1095 SLNs removed, and 7.9% of these SLN...
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#1Robert W. HollowayH-Index: 25
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Abstract The emphasis in contemporary medical oncology has been "precision" or "personalized" medicine, terms that imply a strategy to improve efficacy through targeted therapies. Similar attempts at precision are occurring in surgical oncology. Sentinel lymph node (SLN) mapping has recently been introduced into the surgical staging of endometrial cancer with the goal to reduce morbidity associated with comprehensive lymphadenectomy, yet obtain prognostic information from lymph node status. The ...
169 CitationsSource
#1Anna Jo Bodurtha Smith (Johns Hopkins University)H-Index: 8
#2Amanda Nickles Fader (Johns Hopkins University)H-Index: 54
Last. Edward J. Tanner (Johns Hopkins University)H-Index: 23
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Background In the staging of endometrial cancer, controversy remains regarding the role of sentinel lymph node mapping compared with other nodal assessment strategies. Objective We conducted a systematic review to evaluate the diagnostic accuracy and clinical impact of sentinel lymph node mapping in the management of endometrial cancer. Data Sources We searched Medline, Embase, and the Cochrane Central Registry of Controlled trials for studies published in English before March 25, 2016 (PROSPERO...
160 CitationsSource
#1Hefeng Lin (ZJU: Zhejiang University)H-Index: 1
#2Zheyuan Ding (CDC: Centers for Disease Control and Prevention)H-Index: 1
Last. Jianwei Zhou (ZJU: Zhejiang University)H-Index: 1
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// Hefeng Lin 1 , Zheyuan Ding 2 , Vishnu Goutham Kota 1 , Xiaoming Zhang 1 and Jianwei Zhou 3 1 School of Medicine, Zhejiang University, Hangzhou 310058, China 2 Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China 3 Department of Gynecology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China Correspondence to: Jianwei Zhou, email: Keywords: endometrial cancer, sentinel lymph node mapping, detecti...
42 CitationsSource
#1Robert W. HollowayH-Index: 25
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Background This prospective cohort study aimed to assess sentinel lymph node (SLN) mapping using isosulfan blue (ISB) compared with ISB plus indocyanine green (ICG) and near-infrared imaging (NIR) for patients with endometrial cancer.
39 CitationsSource
#1Andrea PapadiaH-Index: 26
#2Ignacio ZapardielH-Index: 17
Last. Alessandro Buda (University of Milano-Bicocca)H-Index: 21
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Purpose The aim of this study was to compare technetium radiocolloid (Tc99m) + blue dye (BD) versus Indocyanine green (ICG) fluorescent dye in terms of the overall detection rate and bilateral sentinel lymph node (SLN) mapping in patients with endometrial carcinoma.
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