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28.04.2016 | Gynecologic Oncology | Ausgabe 9/2016

Annals of Surgical Oncology 9/2016

From Conventional Radiotracer Tc-99m with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 9/2016
Autoren:
MD Alessandro Buda, MD, PhD Andrea Papadia, MD, PhD Ignacio Zapardiel, MD Enrico Vizza, MD Fabio Ghezzi, MD Elena De Ponti, MD Andrea Alberto Lissoni, MD Sara Imboden, MD Maria Dolores Diestro, MD Debora Verri, MD Maria Luisa Gasparri, MD Beatrice Bussi, MD Giampaolo Di Martino, MD Begoña Diaz de la Noval, MD Michael Mueller, MD Cinzia Crivellaro

Abstract

Background

The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99m) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG).

Methods

Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99m with BD.

Results

Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99m with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99m with BD; this difference was statistically significant (p < 0.0001).

Conclusions

The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.

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