Laparoscopic Sentinel Node Mapping in Endometrial Cancer After Hysteroscopic Injection of Indocyanine Green.

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Abstract

STUDY OBJECTIVE: To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping. DESIGN: Prospectively collected data (Canadian Task Force classification II-2). SETTING: Gynecologic oncology referral center. PATIENTS: Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping. INTERVENTIONS: The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed. MEASUREMENTS AND MAIN RESULTS: A total of 57 procedures was performed. Patient mean age was 60 years (range, 28-80) and mean body mass index was 28.2 kg/m2 (range, 19-43). At least 1 SLN was detected in 89.5% of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95% DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1-8), and in 47% of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5% of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67 had aortic SLN involvement. No adverse events were reported. CONCLUSIONS: Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic.
Original languageUndefined/Unknown
Pages (from-to)89-93
Number of pages5
JournalJournal of Minimally Invasive Gynecology
Volume24
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

Keywords

  • Detection rate, endometrial cancer, Hysteroscopy, Indocyanine green, laparoscopy, Sentinel lymph node

Cite this

@article{b4a4dcdb0577444aa96d462fd837e71a,
title = "Laparoscopic Sentinel Node Mapping in Endometrial Cancer After Hysteroscopic Injection of Indocyanine Green.",
abstract = "STUDY OBJECTIVE: To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping. DESIGN: Prospectively collected data (Canadian Task Force classification II-2). SETTING: Gynecologic oncology referral center. PATIENTS: Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping. INTERVENTIONS: The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed. MEASUREMENTS AND MAIN RESULTS: A total of 57 procedures was performed. Patient mean age was 60 years (range, 28-80) and mean body mass index was 28.2 kg/m2 (range, 19-43). At least 1 SLN was detected in 89.5{\%} of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95{\%} DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1-8), and in 47{\%} of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5{\%} of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67 had aortic SLN involvement. No adverse events were reported. CONCLUSIONS: Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic.",
keywords = "Detection rate, endometrial cancer, Hysteroscopy, Indocyanine green, laparoscopy, Sentinel lymph node",
author = "Fabio Martinelli and Antonino Ditto and Giorgio Bogani and Mauro Signorelli and Valentina Chiappa and Domenica Lorusso and Edward Haeusler and Francesco Raspagliesi",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jmig.2016.09.020",
language = "Non definita",
volume = "24",
pages = "89--93",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Laparoscopic Sentinel Node Mapping in Endometrial Cancer After Hysteroscopic Injection of Indocyanine Green.

AU - Martinelli, Fabio

AU - Ditto, Antonino

AU - Bogani, Giorgio

AU - Signorelli, Mauro

AU - Chiappa, Valentina

AU - Lorusso, Domenica

AU - Haeusler, Edward

AU - Raspagliesi, Francesco

PY - 2017/1/1

Y1 - 2017/1/1

N2 - STUDY OBJECTIVE: To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping. DESIGN: Prospectively collected data (Canadian Task Force classification II-2). SETTING: Gynecologic oncology referral center. PATIENTS: Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping. INTERVENTIONS: The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed. MEASUREMENTS AND MAIN RESULTS: A total of 57 procedures was performed. Patient mean age was 60 years (range, 28-80) and mean body mass index was 28.2 kg/m2 (range, 19-43). At least 1 SLN was detected in 89.5% of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95% DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1-8), and in 47% of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5% of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67 had aortic SLN involvement. No adverse events were reported. CONCLUSIONS: Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic.

AB - STUDY OBJECTIVE: To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping. DESIGN: Prospectively collected data (Canadian Task Force classification II-2). SETTING: Gynecologic oncology referral center. PATIENTS: Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping. INTERVENTIONS: The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed. MEASUREMENTS AND MAIN RESULTS: A total of 57 procedures was performed. Patient mean age was 60 years (range, 28-80) and mean body mass index was 28.2 kg/m2 (range, 19-43). At least 1 SLN was detected in 89.5% of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95% DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1-8), and in 47% of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5% of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67 had aortic SLN involvement. No adverse events were reported. CONCLUSIONS: Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic.

KW - Detection rate, endometrial cancer, Hysteroscopy, Indocyanine green, laparoscopy, Sentinel lymph node

U2 - 10.1016/j.jmig.2016.09.020

DO - 10.1016/j.jmig.2016.09.020

M3 - Articolo

VL - 24

SP - 89

EP - 93

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

IS - 1

ER -