Skip to main content
SpringerLink
Log in

Detection of Sentinel Lymph Nodes in Endometrial Cancer with Intracervical Indocyanine Green Injection and Robotically Assisted Near Infrared Imaging: A Feasibility Study in Indian Setting

  • OriginalPaper
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Objectives

Sentinel lymph node mapping can provide an accurate assessment of the lymph nodes while reducing the morbidity associated with a complete lymphadenectomy. Intracervical indocyanine green (ICG) injection followed by near infrared fluorescent imaging provided high sentinel lymph node (SLN) detection rates with good sensitivity to detect positive nodes. The aim of our study is to analyse the feasibility of sentinel node detection using intracervical ICG injection and fluorescent imaging in an Indian institution.

Methods

From February 2015 till July 2015, all patients with clinically early-stage endometrial cancer undergoing robotic staging surgery at the Amrita Hospital were included in the study. ICG solution (0.5 %) was injected in the cervix and fluorescence was detected with the help of the da Vinci Xi robotic platform.

Results

20 patients underwent SLN mapping during this period. 90 % overall detection rates and 72 % bilateral detection rates were obtained for the procedure. Most common site of sentinel nodes was the obturator fossa followed by the external iliac area. There were no false negatives and the procedure had a 100 % sensitivity in detecting positive nodes.

Conclusion

The technique of SLN mapping with ICG appears simple, safe and feasible even in the learning curve period, providing a high detection rate with excellent sensitivity to detect positive nodes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.

    Article  CAS  PubMed  Google Scholar 

  2. Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–16.

    Article  PubMed  Google Scholar 

  3. Plante M, Touhami O, Trinh X-B, Renaud M-C, Sebastianelli A, Grondin K, Gregoire J. 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(3):443–7.

    Article  PubMed  Google Scholar 

  4. Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, 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;103:714–8.

    Article  PubMed  Google Scholar 

  5. Cragun JM, Havrilesky LJ, Calingaert B, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005;23:3668–75.

    Article  PubMed  Google Scholar 

  6. Kang S, Yoo HJ, Hwang JH, et al. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123(3):522–7 (Epub 2011/09/29).

    Article  PubMed  Google Scholar 

  7. Khoury-Collado F, Murray MP, Hensley ML, et al. Sentinel lymph nodemapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes. Gynecol Oncol. 2011;122(2):251–4 (Epub 2011/05/17).

    Article  CAS  PubMed  Google Scholar 

  8. Ballester M, Dubernard G, Lecuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.

    Article  PubMed  Google Scholar 

  9. How J, Gotlieb WH, Press JZ, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015;137(3):436–42.

    Article  CAS  PubMed  Google Scholar 

  10. Jewell EL, Huang JJ, Abu-Rustum NR, 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(2):274–7.

    Article  PubMed  Google Scholar 

  11. Chino JP, Jones E, Berchuck A, et al. The influence of radiation modality and lymph node dissection on survival in early—stage endometrial cancer. IJROBP. 2012;82(5):1872–9.

    Google Scholar 

  12. Kim CH, Soslow RA, Park KJ, Barber EL, Khoury-Collado F, Barlin JN, et al. Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. Int J Gynecol Cancer. 2013;23(5):964–70.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ballester M, Dubernard G, Bats AS, et al. Comparison of diagnostic accuracy of frozen section with imprint cytology for intraoperative examination of sentinel lymph node in early-stage endometrial cancer: results of Senti-Endo study. Ann Surg Oncol. 2012;19(11):3515–21.

    Article  PubMed  Google Scholar 

  14. Roopesh N, Rajanbabu A, Vijaykumar DK, et al. Sentinel node mapping in endometrial cancer with radioactive colloid injection: a feasibility study. Res Rev: J Oncol Hematol. 2015;4(2):13–6.

    Google Scholar 

Download references

Acknowledgments

We acknowledge the contribution of Dr Walter Henri Gotlieb, Professor, Gynecologic Oncology, McGill University, Montreal, Canada, in guiding us with step by step instructions through the technique of sentinel node detection using Indocyanine green dye injection and also for helping us with detailed editing of this manuscript.

Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India

    Anupama Rajanbabu

  2. Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India

    Vinita Murali

  3. Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 682041, India

    Y. S. Nataraj & D. K. Vijaykumar

Authors
  1. Anupama Rajanbabu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vinita Murali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. S. Nataraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. K. Vijaykumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anupama Rajanbabu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rajanbabu, A., Murali, V., Nataraj, Y.S. et al. Detection of Sentinel Lymph Nodes in Endometrial Cancer with Intracervical Indocyanine Green Injection and Robotically Assisted Near Infrared Imaging: A Feasibility Study in Indian Setting. Indian J Gynecol Oncolog 13, 11 (2015). https://doi.org/10.1007/s40944-015-0020-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-015-0020-6

Keywords

Search

Navigation