We report our initial experience with indocyanine green (ICG) with near-infrared (NIR) fluorescence imaging for sentinel lymph node (SLN) mapping in clinical stage I endometrial cancer.
Methods:
A single center prospective cohort study was carried out from November 2015 to February 2017. Patients with clinically early endometrial cancer undergoing laparoscopic staging surgery and without computed tomography evidence of distant metastases or lymphadenopathy were recruited. The cervical route was utilized for the ICG injection. The SLN was harvested first followed by systematic pelvic lymphadenectomy.
Results:
A total of 35 patients were included in the study. Seven patients opted not to have systematic pelvic lymphadenectomy. The median lymph node count was 18 nodes and the median number of SLNs harvested was 2 per patient. The overall detection rate was 97% (34/35) and bilateral mapping in 88.6% (31/35). There were two patients (5.7%) with positive pelvic lymph nodes and both were identified through SLN biopsy. There were no false negative cases. Four patients (11.4%) were upstaged to stage II or stage IIIC1. There were no allergic reactions or operative complications related to ICG use.
Conclusion:
The role of SLN mapping through ICG-NIR fluorescence imaging in clinical stage I endometrial cancer is highly promising and it appears to be a viable alternative to complete lymphadenectomy for surgical staging.
Get full access to this article
View all access options for this article.
References
1.
National Registry of Diseases Office. Singapore Cancer Registry Annual Registry Report 2015. Singapore: National Registry of Diseases Office, 2017.
2.
HollowayRW, Abu-RustumNR, BackesFJ, et al.Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol, 2017; 146:405.
3.
FrostJA, WebsterKE, BryantA, MorrisonJ. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev, 2015; 9:CD007585.
4.
AgarN, PhilippeAC, BourdelN, et al.Morbidity of pelvic lymphadenectomy and para-aortic lymphadenectomy in endometrial cancer. Bull Cancer, 2015; 102:428.
5.
Abu-RustumNR, AlektiarK, IasonosA, et al.The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: A 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol, 2006; 103:714.
ASTEC Study Group; KitchenerH, SwartAM, QianQ, AmosC, ParmarMK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet, 2009; 373:125.
8.
Benedetti PaniciP, BasileS, ManeschiF, et al.Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical trial. J Natl Cancer Inst, 2008; 100:1707.
9.
CreasmanWT, MorrowCP, BundyBN, HomesleyHD, GrahamJE, HellerPB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer, 1987; 60(8Suppl.):2035.
10.
ChuangL, BurkeTW, TornosC, et al.Staging laparotomy for endometrial carcinoma: Assessment of retroperitoneal lymph nodes. Gynecol Oncol, 1995; 58:189.
11.
CragunJM, HavrileskyLJ, CalingaertB, et al.Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol, 2005; 23:3668.
12.
ChiDS, BarakatRR, PalayekarMJ, et al.The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology. Int J Gynecol Cancer, 2008; 18:269.
13.
GroffB, PougetO, StollF, MathelinC, BaldaufJJ, AkladiosCY. Pertinence of the preoperative exploration in the evaluation of the risk of lymph node metastasis in endometrial cancer. Gynecol ObstetFertil, 2014; 42:92.
14.
ØrtoftG, DueholmM, MathiesenO, et al.Preoperative staging of endometrial cancer using TVS, MRI, and hysteroscopy. Acta Obstet Gynecol Scand, 2013; 92:536.
15.
AntonsenSL, JensenLN, LoftA, et al.MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer—A multicenter prospective comparative study. Gynecol Oncol, 2013; 128:300.
16.
HuangGS, GebbJS, EinsteinMH, ShahabiS, NovetskyAP, GoldbergGL. Accuracy of preoperative endometrial sampling for the detection of high-grade endometrial tumors. Am J Obstet Gynecol, 2007; 196:243.e1.
17.
Bodurtha SmithAJ, FaderAN, TannerEJ. Sentinel lymph node assessment in endometrial cancer: A systematic review and meta-analysis. Am J Obstet Gynecol, 2017; 216:459.
18.
PapadiaA, GasparriML, BudaA, MuellerMD. Sentinel lymph node mapping in endometrial cancer: Comparison of fluorescence dye with traditional radiocolloid and blue. J Cancer Res Clin Oncol, 2017; 143:2039.
19.
RuscitoI, GasparriML, BraicuEI, et al.Sentinel node mapping in cervical and endometrial cancer: Indocyanine green versus other conventional dyes—A meta-analysis. Ann Surg Oncol, 2016; 23:3749.
20.
NiikuraH, Kaiho-SakumaM, TokunagaM, et al.Tracer injection sites and combinations for sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol, 2013; 131:299.
21.
BurkeTW, LevenbackC, TornosC, MorrisM, WhartonJT, GershensonDM. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: Results of a pilot study. Gynecol Oncol, 1996; 62:169.
22.
HolubZ, JaborA, KlimentL. Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer: A pilot study. Eur J Gynaecol Oncol, 2001; 23:53.
23.
PerroneAM, CasadioP, FormelliG, et al.Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol Oncol, 2008; 111:62.
TaşkınS, ŞükürYE, AltınD, et al.Laparoscopic near-infrared fluorescent imaging as an alternative option for sentinel lymph node mapping in endometrial cancer: A prospective study. Int J Surg, 2017; 47:13.
26.
RossiEC, KowalskiLD, ScaliciJ, et al.A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study. Lancet Oncol, 2017; 18384.
27.
BudaA, BussiB, Di MartinoG, Di LorenzoP, PalazziS, GrassiT, MilaniR. Sentinel lymph node mapping with near-infrared fluorescent imaging using indocyanine green: A new tool for laparoscopic platform in patients with endometrial and cervical cancer. J Minim Invasive Gynecol, 2016; 23:265.
28.
PapadiaA, ImbodenS, SiegenthalerF, GasparriML, MohrS, LanzS, MuellerMD. Laparoscopic indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol, 2016; 23:2206.
29.
Khoury-ColladoF, GlaserGE, SivanovicO, et al.Improving sentinel lymph node detection rates in endometrial cancer: How many cases are needed?. Gynecol Oncol, 2009; 115:453.
30.
PapadiaA, ImbodenS, GasparriML, SiegenthalerF, FinkA, MuellerMD. Endometrial and cervical cancer patients with multiple sentinel lymph nodes at laparoscopic ICG mapping: How many are enough?. J Cancer Res Clin Oncol, 2016; 142:1831.
31.
GeppertB, LönnerforsC, BollinoM, PerssonJ. Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications. Gynecol Oncol, 2018; 148:491.
32.
DucieJA, ErikssonAGZ, AliN, et al.Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol, 2017; 147:541.
33.
RossiEC, IvanovaA, BoggessJF. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: A feasibility study. Gynecol Oncol, 2012; 124:78.
34.
HollowayRW, BravoRA, RakowskiJA, JamesJA, JeppsonCN, IngersollSB, AhmadS. Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: A comparison of colorimetric and fluorescence imaging. Gynecol Oncol, 2012; 126:25.
35.
SinnoAK, FaderAN, RocheKL, GiuntoliRL, TannerEJ. A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol, 2014; 134:281.
36.
JewellEL, HuangJJ, Abu-RustumNR, et al.Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol, 2014; 133:274.
37.
PlanteM, TouhamiO, TrinhXB, RenaudMC, SebastianelliA, GrondinK, GregoireJ. Sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial cancer. A pilot study and review of the literature. Gynecol Oncol, 2015; 137:443.
38.
TannerE, PuechlA, LevinsonK, et al.Use of a novel sentinel lymph node mapping algorithm reduces the need for pelvic lymphadenectomy in low-grade endometrial cancer. Gynecol Oncol, 2017; 147:535.
