Sentinel node mapping in endometrial cancer following Hysteroscopic injection of tracers: A single center evaluation over 200 cases

Fabio Martinelli, Antonino Ditto, Mauro Signorelli, Giorgio Bogani, Valentina Chiappa, Domenica Lorusso, Cono Scaffa, Dario Recalcati, Stefania Perotto, Edward Haeusler, Francesco Raspagliesi

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Abstract

Objectives To analyze detection-rate(DR) and diagnostic-accuracy (A) of sentinel-nodes(SLNs) mapping following hysteroscopic-injection of tracer. To compare DR and A between tracers: ICG and Tc99m. Methods Evaluation of endometrial-cancer patients who underwent SLNs mapping after hysteroscopic-peritumoral-injection of tracer ± lymphadenectomy. Analysis of DR (overall-bilateral-aortic) and A in the entire cohort and comparison between tracers. Results 202 procedures were performed from January/2005 to February/2017. Mean age:60 years (28–82); mean BMI: 26.8 kg/m2 (15–47). In 133 cases (65.8%) hysterectomy and mapping procedure were performed laparoscopically. The overall-DR of the technique was 93.2% (179/192) (10 cases were excluded: 9 for technical-equipment failure; 1 for vagal reaction). Bilateral pelvic mapping was found in 59.7% of cases (107/179) and was more frequent in the ICG group (72.8% vs 53.3%; p: 0.012). In 50.8% of cases (91/179) SLNs were mapped both in pelvic and aortic nodes, and in 5 cases (2.8%) only in the aortic area. The mean number of detected SLNs was 3.7 (1–8). 22 patients (12.3%) had nodal involvement: 10-(45.5%)-macrometastases; 5-(22.7%)-micrometastases; 7-(31.8%)-ITCs. In 6 cases (27.3%) only aortic nodes were positive; in 5 cases (22.7%) both pelvic and aortic nodes and in 11 cases (50%) only pelvic nodes were involved. Three false-negative results were found, all in the Tc99m group. All had isolated aortic metastases with negative pelvic nodes. Overall-sensitivity was 86.4% (95%CI: 68.4–100) and overall-negative-predictive-value (NPV) was 96.4% (95%CI 86.7–100). No differences in terms of overall-DR, overall-sensitivity and overall-NPV were found between the two tracers. Conclusions Hysteroscopic-injection of tracer for SLNs mapping in endometrial cancer is as accurate as cervical injection with a higher DR in the aortic area. ICG improves bilateral-DR. Further investigation is warranted on this topic.

Original languageEnglish
Pages (from-to)525-530
Number of pages6
JournalGynecologic Oncology
Volume146
Issue number3
DOIs
Publication statusPublished - Sep 1 2017

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Endometrial Neoplasms
Injections
Equipment Failure
Neoplasm Micrometastasis
Lymph Node Excision
Hysterectomy
cyhalothrin
Neoplasm Metastasis

Keywords

  • Aortic nodes
  • Diagnostic accuracy
  • Endometrial cancer
  • Hysteroscopy
  • Indocyanine green/Tc99m
  • Sentinel node

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{7455d15e1bd14a49891b1dfdd1c02e63,
title = "Sentinel node mapping in endometrial cancer following Hysteroscopic injection of tracers: A single center evaluation over 200 cases",
abstract = "Objectives To analyze detection-rate(DR) and diagnostic-accuracy (A) of sentinel-nodes(SLNs) mapping following hysteroscopic-injection of tracer. To compare DR and A between tracers: ICG and Tc99m. Methods Evaluation of endometrial-cancer patients who underwent SLNs mapping after hysteroscopic-peritumoral-injection of tracer ± lymphadenectomy. Analysis of DR (overall-bilateral-aortic) and A in the entire cohort and comparison between tracers. Results 202 procedures were performed from January/2005 to February/2017. Mean age:60 years (28–82); mean BMI: 26.8 kg/m2 (15–47). In 133 cases (65.8{\%}) hysterectomy and mapping procedure were performed laparoscopically. The overall-DR of the technique was 93.2{\%} (179/192) (10 cases were excluded: 9 for technical-equipment failure; 1 for vagal reaction). Bilateral pelvic mapping was found in 59.7{\%} of cases (107/179) and was more frequent in the ICG group (72.8{\%} vs 53.3{\%}; p: 0.012). In 50.8{\%} of cases (91/179) SLNs were mapped both in pelvic and aortic nodes, and in 5 cases (2.8{\%}) only in the aortic area. The mean number of detected SLNs was 3.7 (1–8). 22 patients (12.3{\%}) had nodal involvement: 10-(45.5{\%})-macrometastases; 5-(22.7{\%})-micrometastases; 7-(31.8{\%})-ITCs. In 6 cases (27.3{\%}) only aortic nodes were positive; in 5 cases (22.7{\%}) both pelvic and aortic nodes and in 11 cases (50{\%}) only pelvic nodes were involved. Three false-negative results were found, all in the Tc99m group. All had isolated aortic metastases with negative pelvic nodes. Overall-sensitivity was 86.4{\%} (95{\%}CI: 68.4–100) and overall-negative-predictive-value (NPV) was 96.4{\%} (95{\%}CI 86.7–100). No differences in terms of overall-DR, overall-sensitivity and overall-NPV were found between the two tracers. Conclusions Hysteroscopic-injection of tracer for SLNs mapping in endometrial cancer is as accurate as cervical injection with a higher DR in the aortic area. ICG improves bilateral-DR. Further investigation is warranted on this topic.",
keywords = "Aortic nodes, Diagnostic accuracy, Endometrial cancer, Hysteroscopy, Indocyanine green/Tc99m, Sentinel node",
author = "Fabio Martinelli and Antonino Ditto and Mauro Signorelli and Giorgio Bogani and Valentina Chiappa and Domenica Lorusso and Cono Scaffa and Dario Recalcati and Stefania Perotto and Edward Haeusler and Francesco Raspagliesi",
year = "2017",
month = "9",
day = "1",
doi = "10.1016/j.ygyno.2017.06.014",
language = "English",
volume = "146",
pages = "525--530",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - Sentinel node mapping in endometrial cancer following Hysteroscopic injection of tracers

T2 - A single center evaluation over 200 cases

AU - Martinelli, Fabio

AU - Ditto, Antonino

AU - Signorelli, Mauro

AU - Bogani, Giorgio

AU - Chiappa, Valentina

AU - Lorusso, Domenica

AU - Scaffa, Cono

AU - Recalcati, Dario

AU - Perotto, Stefania

AU - Haeusler, Edward

AU - Raspagliesi, Francesco

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objectives To analyze detection-rate(DR) and diagnostic-accuracy (A) of sentinel-nodes(SLNs) mapping following hysteroscopic-injection of tracer. To compare DR and A between tracers: ICG and Tc99m. Methods Evaluation of endometrial-cancer patients who underwent SLNs mapping after hysteroscopic-peritumoral-injection of tracer ± lymphadenectomy. Analysis of DR (overall-bilateral-aortic) and A in the entire cohort and comparison between tracers. Results 202 procedures were performed from January/2005 to February/2017. Mean age:60 years (28–82); mean BMI: 26.8 kg/m2 (15–47). In 133 cases (65.8%) hysterectomy and mapping procedure were performed laparoscopically. The overall-DR of the technique was 93.2% (179/192) (10 cases were excluded: 9 for technical-equipment failure; 1 for vagal reaction). Bilateral pelvic mapping was found in 59.7% of cases (107/179) and was more frequent in the ICG group (72.8% vs 53.3%; p: 0.012). In 50.8% of cases (91/179) SLNs were mapped both in pelvic and aortic nodes, and in 5 cases (2.8%) only in the aortic area. The mean number of detected SLNs was 3.7 (1–8). 22 patients (12.3%) had nodal involvement: 10-(45.5%)-macrometastases; 5-(22.7%)-micrometastases; 7-(31.8%)-ITCs. In 6 cases (27.3%) only aortic nodes were positive; in 5 cases (22.7%) both pelvic and aortic nodes and in 11 cases (50%) only pelvic nodes were involved. Three false-negative results were found, all in the Tc99m group. All had isolated aortic metastases with negative pelvic nodes. Overall-sensitivity was 86.4% (95%CI: 68.4–100) and overall-negative-predictive-value (NPV) was 96.4% (95%CI 86.7–100). No differences in terms of overall-DR, overall-sensitivity and overall-NPV were found between the two tracers. Conclusions Hysteroscopic-injection of tracer for SLNs mapping in endometrial cancer is as accurate as cervical injection with a higher DR in the aortic area. ICG improves bilateral-DR. Further investigation is warranted on this topic.

AB - Objectives To analyze detection-rate(DR) and diagnostic-accuracy (A) of sentinel-nodes(SLNs) mapping following hysteroscopic-injection of tracer. To compare DR and A between tracers: ICG and Tc99m. Methods Evaluation of endometrial-cancer patients who underwent SLNs mapping after hysteroscopic-peritumoral-injection of tracer ± lymphadenectomy. Analysis of DR (overall-bilateral-aortic) and A in the entire cohort and comparison between tracers. Results 202 procedures were performed from January/2005 to February/2017. Mean age:60 years (28–82); mean BMI: 26.8 kg/m2 (15–47). In 133 cases (65.8%) hysterectomy and mapping procedure were performed laparoscopically. The overall-DR of the technique was 93.2% (179/192) (10 cases were excluded: 9 for technical-equipment failure; 1 for vagal reaction). Bilateral pelvic mapping was found in 59.7% of cases (107/179) and was more frequent in the ICG group (72.8% vs 53.3%; p: 0.012). In 50.8% of cases (91/179) SLNs were mapped both in pelvic and aortic nodes, and in 5 cases (2.8%) only in the aortic area. The mean number of detected SLNs was 3.7 (1–8). 22 patients (12.3%) had nodal involvement: 10-(45.5%)-macrometastases; 5-(22.7%)-micrometastases; 7-(31.8%)-ITCs. In 6 cases (27.3%) only aortic nodes were positive; in 5 cases (22.7%) both pelvic and aortic nodes and in 11 cases (50%) only pelvic nodes were involved. Three false-negative results were found, all in the Tc99m group. All had isolated aortic metastases with negative pelvic nodes. Overall-sensitivity was 86.4% (95%CI: 68.4–100) and overall-negative-predictive-value (NPV) was 96.4% (95%CI 86.7–100). No differences in terms of overall-DR, overall-sensitivity and overall-NPV were found between the two tracers. Conclusions Hysteroscopic-injection of tracer for SLNs mapping in endometrial cancer is as accurate as cervical injection with a higher DR in the aortic area. ICG improves bilateral-DR. Further investigation is warranted on this topic.

KW - Aortic nodes

KW - Diagnostic accuracy

KW - Endometrial cancer

KW - Hysteroscopy

KW - Indocyanine green/Tc99m

KW - Sentinel node

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U2 - 10.1016/j.ygyno.2017.06.014

DO - 10.1016/j.ygyno.2017.06.014

M3 - Article

C2 - 28625394

AN - SCOPUS:85020813809

VL - 146

SP - 525

EP - 530

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

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