Indocyanine green can stand alone in detecting sentinel lymph nodes in cervical cancer.
Ulain Qurat,Han Lu,Wu Qian,Zhao Lanbo,Wang Qi,Tuo Xiaoqian,Wang Yiran,Wang Qing,Ma Sijia,Sun Chao,Song Qing,Li Qiling
The Journal of international medical research
OBJECTIVES:The effectiveness of indocyanine green (ICG) dye for detecting sentinel lymph nodes (SLNs) in cervical cancer compared with other tracers is unknown. This study aimed to assess the validity of ICG dye in detecting SLNs in cervical cancer preoperatively. METHODS:We performed a literature search for identifying eligible articles from PubMed database using the search terms "cervical cancer", "sentinel lymph node", "indocyanine green", "blue dyes", "human serum albumin", and "technetium-99 radiocolloid". We performed a meta-analysis. Comparison of the overall, bilateral, and unilateral detection rates of the different tracers was the primary goal. Comparison of the false-negative rate among the tracers was the secondary goal. RESULTS:Only eight retrospective studies including 661 patients were included. ICG versus combinations of three other tracers showed significantly higher bilateral and unilateral detection rates, but no difference in the overall rate of detecting SLNs. ICG had a higher bilateral detection rate than blue dye and technetium-99. Absorbing human serum albumin into ICG as a lymphatic tracer did not show a difference in detection rate compared with ICG alone. CONCLUSIONS:ICG is superior and better than other tracers, and absorbing human serum albumin as a lymphatic tracer is not required in patients with cervical cancer.
10.1177/0300060518803041
Diagnostic evaluation of sentinel lymph node biopsy in early head and neck squamous cell carcinoma: a meta-analysis.
Yamauchi Kohichi,Kogashiwa Yasunao,Nakamura Takehiro,Moro Yorihisa,Nagafuji Hiroshi,Kohno Naoyuki
Head & neck
BACKGROUND:The purpose of this study was to evaluate the efficacy of sentinel lymph node biopsy (SLNB) in early head and neck squamous cell carcinoma (HNSCC). METHODS:The PubMed database was searched for studies published before October 31, 2012. Pooled values for the sentinel lymph node identification rate, sensitivity, false-negative rate, negative predictive value, and accuracy were calculated. RESULTS:A total of 16 studies (987 patients) was included. The pooled identification rate, sensitivity, false-negative rate, negative predictive value, and accuracy were 95.2%, 86.3%, 13.7%, 94.2%, and 95.0%, respectively. The subgroup with high methodological quality showed a mean identification rate of 95.4% for SLNB validation trials and 94.2% for SLNB alone trials, and mean sensitivity of 91.0% for SLNB validation trials and 84.2% for SLNB alone trials. CONCLUSION:The SLNB procedure has shown a high sensitivity rate, but the pooled sensitivity and false-negative rate were worse in SLNB alone trials than in SLNB validation trials.
10.1002/hed.23526
Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications.
Geppert Barbara,Lönnerfors Céline,Bollino Michele,Persson Jan
Gynecologic oncology
OBJECTIVE:To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. METHODS:A prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. RESULTS:The bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33min whereas 91min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p=0.0003). CONCLUSION:The high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.
10.1016/j.ygyno.2017.12.017
The combination of preoperative PET/CT and sentinel lymph node biopsy in the surgical management of early-stage cervical cancer.
Papadia Andrea,Gasparri Maria Luisa,Genoud Sophie,Bernd Klaeser,Mueller Michael D
Journal of cancer research and clinical oncology
INTRODUCTION:The aim of the study was to evaluate the use of PET/CT and/or SLN mapping alone or in combination in cervical cancer patients. MATERIALS AND METHODS:Data on stage IA1-IIA cervical cancer patients undergoing PET/CT and SLN mapping were retrospectively collected. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT and SLN mapping, alone or in combination, in identifying cervical cancer patients with lymph node metastases were calculated. RESULTS:Sixty patients met the inclusion criteria. PET/CT showed a sensitivity of 68%, a specificity of 84%, a PPV of 61% and a NPV of 88% in detecting lymph nodal metastases. SLN mapping showed a sensitivity of 93%, a specificity of 100%, a PPV of 100% and a NPV of 97%. The combination of PET/CT and SLN mapping showed a sensitivity of 100%, a specificity of 86%, a PPV of 72% and a NPV of 100%. For patients with tumors of >2 cm in diameter, the PET/CT showed a sensitivity of 68%, a specificity of 72%, a PPV of 61% and a NPV of 86%. SLN mapping showed a sensitivity of 93%, a specificity of 100%, a PPV of 100% and a NPV of 95%. The combination of PET/CT and SLN mapping showed a sensitivity of 100%, a specificity of 76%, a PPV of 72% and a NPV of 100%. CONCLUSION:PET/CT represents a "safety net" that helps the surgeon in identifying metastatic lymph nodes, especially in patients with larger tumors.
10.1007/s00432-017-2467-6
Sentinel lymph node biopsy alone in the management of early cervical carcinoma.
Devaja Omer,Papadopoulos Andreas John,Bharathan Rasiah,Montalto Stephen Attard,Coutts Michael,Tan Alex,Corrigan Alexis,Perovic Milica,Lalami Seyedeh Zahra Rezaei
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
OBJECTIVE:Sentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy in the management of early cervical carcinoma using a double technique (technetium-99m (Tc-99m) nanocolloid and methylene blue dye injection). METHODS:This was a 10-year study from January 2009 to January 2019 that recruited 103 consecutive women undergoing surgery for early cervical carcinoma, FIGO 2009 stage IA1 (grade 3, and grade 2 with lymphovascular space invasion) to IB1 (<2 cm), at the West Kent Gynaecological Oncology Centre, Maidstone, UK. All patients were given the choice of pelvic node dissection and SLN mapping or SLN only. All patients elected to undergo SLN only. In total 97 patients had SLN mapping performed laparoscopically. We used the combined method (Tc-99m nanocolloid and/or methylene blue dye). All SLN routinely underwent ultrastaging. RESULTS:At least one SLN was detected in all 103 patients, using at least one of the combined methods (Tc-99m nanocolloid or blue dye). Bilaterally SLN were removed in 85/103 women with an 83% bilateral detection rate. The median SLN count was 2.3 (range 1-6) nodes. Of 103 patients, 7 (6.7%) patients had lymph node involvement. There were no pelvic or para-aortic lymph node recurrences with a median follow-up of 53 (range 8-120) months. The specificity and negative predictive value of a negative SLN was 100%. None of our 103 patients reported lower extremity lymphedema. CONCLUSION:In carefully selected patients with early cervical carcinoma, SLN biopsy alone appears to be a safe method for lymph node assessment of women undergoing surgical staging. Ultrastaging is an essential part of histologic examination of SLN.
10.1136/ijgc-2019-001082
The role of sentinel lymph nodes in endometrial and cervical cancer.
Smith Blair,Backes Floor
Journal of surgical oncology
Sentinel lymph node assessment aims to determine lymphatic spread while preventing unnecessary interventions and morbidity for those who will not benefit from lymphadenectomy. All detection methods have demonstrated reasonable sensitivity with a low false negative rate and high negative predictive value; as long as the surgeon removes all enlarged lymph nodes and a site-specific lymphadenectomy is performed if there is no mapping. The significance of micrometastases and long term outcomes are yet to be determined.
10.1002/jso.24022
The Safety and Effectiveness of Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer During Pregnancy.
Yoshihara Kosuke,Ishiguro Tatsuya,Chihara Makoto,Shima Eiri,Adachi Sosuke,Isobe Masanori,Haino Kazufumi,Yamaguchi Masayuki,Sekine Masayuki,Kashima Katsunori,Takakuwa Koichi,Nishikawa Nobumichi,Enomoto Takayuki
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
OBJECTIVES:Cervical cancer is one of the most frequently diagnosed cancers in pregnancy. Our aim was to evaluate the safety and efficacy of abdominal radical trachelectomy (ART) for pregnant women with early-stage cervical cancer who strongly desire to preserve their pregnancies. METHODS/MATERIALS:A retrospective observational study was performed for stage IB1 cervical cancer patients who underwent ART or radical hysterectomy (RH) at our hospital between February 2013 and June 2017. We compared differences in perioperative findings and oncologic outcomes among ART during pregnancy (ART-DP), ART, and RH groups. RESULTS:A total of 38 patients were included in this analysis. Six, 10, and 22 patients were assigned to the ART-DP, ART, and RH groups, respectively. There were no significant differences in the distribution of pathological TNM classifications, histology, tumor size, stromal invasion, and lymph-vascular space invasion among the 3 groups. The patients in the ART-DP group were younger than those in the RH group (P = 0.014). The ART-DP group was associated with more blood loss and prolonged surgery compared with the RH group (P = 0.017 and P = 0.014). The number of total lymph nodes in the ART-DP group was lower than that in the RH group (P = 0.036). However, there were no significant differences in age, surgical time, blood loss, or lymph node count between the ART-DP and ART groups. There were no significant differences in progression-free and overall survival times among the 3 groups, and no recurrence was observed in the ART-DP group. CONCLUSIONS:Abdominal radical trachelectomy may be a tolerable treatment option for pregnant women with early-stage cervical cancer who strongly desire a baby.
10.1097/IGC.0000000000001218
Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions.
Cibula David,McCluggage W Glenn
Gynecologic oncology
Sentinel lymph node (SLN) biopsy has been increasingly used in the management of early-stages cervical cancer instead of systematic pelvic lymph node dissection (PLND). The aim of this article is to give a critical overview of key aspects related to this concept, such as a necessity for reliable detection of micrometastases (MIC) in SLN and the requirements for SLN pathologic ultrastaging, low accuracy of intraoperative detection of SLN involvement, and still a limited evidence of oncological safety of the replacement of PLND by SLN biopsy only in ≥IB1 tumours due to unknown risk of MIC in non-SLN pelvic lymph nodes in patients with negative SLN, and absence of any prospective evidence.
10.1016/j.ygyno.2018.10.007
Frozen Section for Detection of Lymph Nodes After Cervical Injection with Indocyanine Green (ICG) for Sentinel Lymph Node Technique in Endometrial Cancer Staging.
Casarin Jvan,Multinu Francesco,Pasupathy Kalyan,Weaver Amy,McGree Michaela,Tortorella Lucia,Torres Diogo,Kumar Amanika,Langstraat Carrie,Huang Yajue,Ghezzi Fabio,Mariani Andrea,Glaser Gretchen
Annals of surgical oncology
OBJECTIVE:The aim of this study was to assess the role of frozen section (FS) in identifying an absence of lymph nodes during sentinel lymph node (SLN) biopsy for apparent early-stage endometrial cancer (EC). METHODS:Consecutive apparent early-stage EC patients who had SLNs removed after cervical injection with indocyanine green (ICG) from 1 June 2014 to 30 June 2016 were analyzed. An empty node (EN) was defined as an SLN specimen without evidence of lymph node(s). The association of tumor and patient characteristics with an EN was evaluated, and trend analysis to compare the rate of ENs over calendar quarters was performed. A decision-tree model was then created to compare the use of FS versus no FS for SLN evaluation in the hypothetical cohort affected by early-stage EC in the US each year. RESULTS:Over the study period, 300 patients met the inclusion criteria. FS revealed ENs in 24 (8%) patients. No association between patient demographic characteristics (age, body mass index, prior abdominopelvic surgery, international federation of gynecology and obstetrics (FIGO) stage, histology, myometrial invasion, cervical stromal invasion) and presence of ENs was observed. The rate of ENs at FS did not change over time (p = 0.68). The hypothetical analysis showed a 4.3% decrease of inappropriately staged patients with the use of FS on the SLN (95% confidence interval 4.1-4.5). CONCLUSIONS:ENs during SLN biopsy for EC staging is not a rare event and can be easily detected with FS. The implementation of FS of SLN might reduce inadequate staging of EC. Individual institutions may want to examine their own EN rates and determine if this would assist them in their SLN practices for EC.
10.1245/s10434-018-6698-9
Indocyanine Green versus Radiotracer with or without Blue Dye for Sentinel Lymph Node Mapping in Stage >IB1 Cervical Cancer (>2 cm).
Di Martino Giampaolo,Crivellaro Cinzia,De Ponti Elena,Bussi Beatrice,Papadia Andrea,Zapardiel Ignacio,Vizza Enrico,Elisei Federica,Diestro Maria Dolores,Locatelli Luca,Gasparri Maria Luisa,Di Lorenzo Paolo,Mueller Michael,Buda Alessandro
Journal of minimally invasive gynecology
STUDY OBJECTIVE:To compare sentinel lymph node (SLN) mapping in women with cervical cancer stage >IB1 (tumor size >2 cm) using indocyanine green (ICG) versus the standard technique using radioisotope technetium 99m radiocolloid (Tc99) radiotracer with or without blue dye. DESIGN:European multicenter, retrospective observational study (Canadian Task Force classification II-2). SETTING:Four academic medical centers. PATIENTS:Ninety-five women with stage IB1 cervical cancer (>2 cm) who underwent SLN mapping with Tc99 with or without blue dye or ICG and radical hysterectomy. INTERVENTION:The detection rate and bilateral mapping rate were compared between ICG and standard Tc99 radiotracer with or without blue dye. Lymphadenectomy was performed, and the false-negative rate was assessed. MEASUREMENTS AND MAIN RESULTS:Forty-seven patients underwent SLN mapping with Tc99 with or without blue dye, and 48 did so with ICG. All patients underwent radical hysterectomy with or without bilateral salpingo-oophorectomy between 2008 and 2016. The overall detection rate of SLN mapping was 91.5% for Tc99 with or without blue dye and 100% for ICG. A 91.7% rate of bilateral migration was achieved for ICG, significantly higher than the 66% obtained with Tc99 with or without blue dye (p = .025). Nine of the 23 SLN-positive patients (39.1%) were diagnosed exclusively as a result of the ultrastaging used to identify micrometastases or isolated tumor cells only. CONCLUSIONS:In advanced cervical cancer (stage IB1 >2 cm), the detection rate and bilateral migration rate on real-time fluorescent SLN mapping were higher with ICG than with Tc99 radiotracer with or without blue dye. SLN mapping and ultrastaging can provide additional information for nodal staging in advanced cervical cancer. In this setting, ICG is a promising tool for mapping, appearing less affected by higher disease stage compared with traditional methods.
10.1016/j.jmig.2017.05.011
Sentinel Lymph Nodes Mapping in Cervical Cancer a Comprehensive Review.
Diab Yasser
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
OBJECTIVE:A comprehensive literature search for more recent studies pertaining to sentinel lymph node mapping in the surveillance of cervical cancer to assess if sentinel lymph node mapping has sensitivity and specificity for evaluation of the disease; assessment of posttreatment response and disease recurrence in cervical cancer. MATERIALS AND METHODS:The literature review has been constructed on a step wise study design that includes 5 major steps. This includes search for relevant publications in various available databases, application of inclusion and exclusion criteria for the selection of relevant publications, assessment of quality of the studies included, extraction of the relevant data and coherent synthesis of the data. RESULTS:The search yielded numerous studies pertaining to sentinel lymph node mapping, especially on the recent trends, comparison between various modalities and evaluation of the technique. Evaluation studies have appraised high sensitivity, high negative predictive values and low false-negative rate for metastasis detection using sentinel lymph node mapping. Comparative studies have established that of all the modalities for sentinel lymph node mapping, indocyanine green sentinel lymph node mapping has higher overall and bilateral detection rates. Corroboration of the deductions of these studies further establishes that the sentinel node detection rate and sensitivity are strongly correlated to the method or technique of mapping and the history of preoperative neoadjuvant chemotherapy. CONCLUSIONS:The review takes us to the strong conclusion that sentinel lymph node mapping is an ideal technique for detection of sentinel lymph nodes in cervical cancer patients with excellent detection rates and high sensitivity. The review also takes us to the supposition that a routine clinical evaluation of sentinel lymph nodes is feasible and a real-time florescence mapping with indocyanine green dye gives better statistically significant overall and bilateral detection than methylene blue.
10.1097/IGC.0000000000000853
Sentinel lymph node biopsy and morbidity outcomes in early cervical cancer: Results of a multicentre randomised trial (SENTICOL-2).
Mathevet Patrice,Lécuru Fabrice,Uzan Catherine,Boutitie Florent,Magaud Laurent,Guyon Frederic,Querleu Denis,Fourchotte Virginie,Baron Marc,Bats Anne-Sophie,
European journal of cancer (Oxford, England : 1990)
INTRODUCTION:Pelvic lymph node dissection has been the standard of care for patients with early cervical cancer. Sentinel node (SN) mapping is safe and feasible and may increase the detection of metastatic disease, but benefits of omitting pelvic lymph node dissection in terms of decreased morbidity have not been demonstrated. MATERIALS AND METHODS:In an open-label study, patients with early cervical carcinoma (FIGO 2009 stage IA2 to IIA1) were randomly assigned to SN resection alone (SN arm) or SN and pelvic lymph node dissection (SN + PLND arm). SN resection was followed by radical surgery of the tumour (radical hysterectomy or radical trachelectomy). The primary end-point was morbidity related to the lymph node dissection; 3-year recurrence-free survival was a secondary end-point. RESULTS:A total of 206 patients were eligible and randomly assigned to the SN arm (105 patients) or SN + PLND arm (101 patients). Most patients had stage IB1 lesion (87.4%). No false-negative case was observed in SN + PLND arm. Lymphatic morbidity was significantly lower in the SN arm (31.4%) than in the SN + PLND arm (51.5%; p = 0.0046), as was the rate of postoperative neurological symptoms (7.8% vs. 20.6%, p = 0.01, respectively). However, there was no significant difference in the proportion of patients with significant lymphoedema between the two groups. During the 6-month postoperative period, the difference in morbidity decreased over time. The 3-year recurrence-free survival was not significantly different (92.0% in SN arm and 94.4% in SN + PLND arm). CONCLUSION:SN resection alone is associated with early decreased lymphatic morbidity when compared with SN + PLND in early cervical cancer.
10.1016/j.ejca.2021.02.009