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Value of indocyanine green pelvic lymph node mapping in the surgical approach of cervical cancer

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Lymph node metastasis is a significant predictive factor for disease recurrence and survival in cervical cancer patients and relevant for therapeutic strategies. We evaluated the clinical value of indocyanine green (ICG) by measuring the sensitivity and negative predictive value of sentinel lymph node mapping compared with the gold standard of complete lymphadenectomy in detecting lymph node metastases for cervical cancer.

Methods

We utilized the near-infrared imaging agent ICG to detect tumor-infested lymph nodes in the pelvis analogue to a classical sentinel lymph node procedure by analyzing data from 20 patients who had undergone surgery for cervical cancer at our institution. A laparoscopic lymph node mapping procedure by means of ICG, followed by a complete pelvic lymphadenectomy with or without paraaortic lymphadenectomy was done in all patients.

Results

Histological examination identified seven patients with tumor-positive pelvic nodes, whereas mapping with ICG identified only five of these patients. Detection rate of positive nodes by ICG mapping and false negative rate was 71.4% and 28.6%, respectively; bilateral detection rate was 83.3%. One of the two false negative patients additionally suffered from deep infiltrating endometriosis.

Conclusions

Our results indicate that ICG can identify the relevant pelvic nodes independent of tumor size, provided bilateral detection is achieved and additional, related diseases are excluded.

Trial Registration

This trial is registered within the German Clinical Trial Register (DRKS-ID: DRKS00014692).

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany

    Thomas Papathemelis & Anton Scharl

  2. Department Ob/Gyn, University of Witten-Herdecke, KKH Dormagen, Dormagen, Germany

    Michael Anapolski

  3. Department of Gynecology and Obstetrics, University Medical Center, Landshuter Str. 65, 93053, Regensburg, Germany

    Elisabeth C. Inwald, Atanas Ignatov & Olaf Ortmann

  4. Tumor Center, University of Regensburg, Regensburg, Germany

    Michael Gerken & Monika Klinkhammer-Schalke

  5. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Sophia Scharl

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  1. Thomas Papathemelis
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Correspondence to Thomas Papathemelis.

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Papathemelis, T., Scharl, A., Anapolski, M. et al. Value of indocyanine green pelvic lymph node mapping in the surgical approach of cervical cancer. Arch Gynecol Obstet 301, 787–792 (2020). https://doi.org/10.1007/s00404-020-05457-x

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