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Journal of Cancer Research and Clinical Oncology

, Volume 144, Issue 7, pp 1385–1393 | Cite as

Retrospective validation of the laparoscopic ICG SLN mapping in patients with grade 3 endometrial cancer

  • Andrea Papadia
  • Maria Luisa Gasparri
  • Anda P. Radan
  • Chantal A. L. Stämpfli
  • Tilman T. Rau
  • Michael D. Mueller
Original Article – Clinical Oncology

Abstract

Purpose

To evaluate the sensitivity, negative predictive value (NPV) and false-negative (FN) rate of the near infrared (NIR) indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with poorly differentiated endometrial cancer who have undergone a full pelvic and para-aortic lymphadenectomy after SLN mapping.

Methods

We performed a retrospective analysis of patients with endometrial cancer undergoing a laparoscopic NIR-ICG SLN mapping followed by a systematic pelvic and para-aortic lymphadenectomy. Inclusion criteria were a grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) and a completion pelvic and para-aortic lymphadenectomy to the renal vessels after SLN mapping. Overall and bilateral detection rates, sensitivity, NPV, and FN rates were calculated.

Results

From December 2012 until January 2017, 42 patients fulfilled inclusion criteria. Overall and bilateral detection rates were 100 and 90.5%, respectively. Overall, 23.8% of the patients had lymph node metastases. In one patient, despite negative bilateral pelvic SLNs, a metastatic non-SLN-isolated para-aortic metastasis was detected. This NSLN was clinically suspicious and sent to frozen section analysis during the surgery. FN rate, sensitivity, and NPV were 10, 90, and 97.1%, respectively. For the SLN mapping algorithm, FN rate, sensitivity, and NPV were 0, 100, and 100%, respectively.

Conclusions

Laparoscopic NIR-ICG SLN mapping in high-risk endometrial cancer patients has acceptable sensitivity, FN rate, and NPV.

Keywords

Endometrial cancer Sentinel lymph node biopsy Grade 3 Uterine papillary serous carcinoma Clear cell carcinoma Carcinosarcomas 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. ASTEC Study Group, Kitchener H, Swart AM et al (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136CrossRefGoogle Scholar
  2. Ballester M, Dubernard G, Lécuru F et al (2011) Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol 12:469–476CrossRefPubMedGoogle Scholar
  3. Barlin JN, Khoury-Collado F, Kim CH et al (2012) The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol 125:531–535CrossRefPubMedGoogle Scholar
  4. Benedetti Panici P, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716CrossRefPubMedGoogle Scholar
  5. Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E, Lissoni AA, Imboden S, Diestro MD, Verri D, Gasparri ML, Bussi B, Di Martino G, de la Noval BD, Mueller M, Crivellaro C (2016) From conventional radiotracer Tc-99(m) with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol 23:2959–2965CrossRefPubMedGoogle Scholar
  6. Buda A, Papadia A, Di Martino G, Imboden S, Bussi B, Guerra L, De Ponti E, Reato C, Gasparri ML, Crivellaro C, Mueller M (2017) Real-time fluorescent sentinel lymph node mapping with indocyanine green in women with previous conization undergoing laparoscopic surgery for early invasive cervical cancer: comparison with radiotracer ± blue dye. J Minim Invasive Gynecol 25:455–460CrossRefPubMedGoogle Scholar
  7. Colombo N, Creutzberg C, Amant F et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 27:16–41CrossRefPubMedGoogle Scholar
  8. Creasman WT, Morrow CP, Bundy BN et al (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041CrossRefPubMedGoogle Scholar
  9. Di Martino G, Crivellaro C, De Ponti E, Bussi B, Papadia A, Zapardiel I, Vizza E, Elisei F, Diestro MD, Locatelli L, Gasparri ML, Di Lorenzo P, Mueller M, Buda A (2017) Indocyanine green versus radiotracer with or without blue dye for sentinel lymph node mapping in stage> IB1 cervical cancer (> 2 cm). J Minim Invasive Gynecol 24:954–959CrossRefPubMedGoogle Scholar
  10. Ditto A, Martinelli F, Bogani G et al (2015) Sentinel node mapping using hysteroscopic injection of indocyanine green and laparoscopic near-infrared fluorescence imaging in endometrial cancer staging. J Minim Invasive Gynecol 22:132–133CrossRefPubMedGoogle Scholar
  11. Ducie JA, Eriksson AGZ, Ali N et al (2017) Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol 147:541–548CrossRefPubMedGoogle Scholar
  12. Ehrisman J, Secord AA, Berchuck A et al (2016) Performance of sentinel lymph node biopsy in high-risk endometrial cancer. Gynecol Oncol Rep 17:69–71CrossRefPubMedPubMedCentralGoogle Scholar
  13. Eriksson AG, Montovano M, Beavis A et al (2016) Impact of obesity on sentinel lymph node mapping in patients with newly diagnosed uterine cancer undergoing robotic surgery. Ann Surg Oncol 23:2522–2528CrossRefPubMedGoogle Scholar
  14. FIGO (1989) FIGO stages 1988 revision. Gynecol Oncol 35:125–127CrossRefGoogle Scholar
  15. Geppert B, Lönnerfors C, Bollino M et al (2017) A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol 45:256–261CrossRefGoogle Scholar
  16. Holloway RW, Ahmad S, Kendrick JE et al (2017) A prospective cohort study comparing colorimetric and fluorescent imaging for sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol 24:1972–1979CrossRefPubMedGoogle Scholar
  17. Imboden S, Papadia A, Nauwerk M, McKinnon B, Kollmann Z, Mohr S, Lanz S, Mueller MD (2015) A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol 22:4198–4203CrossRefPubMedPubMedCentralGoogle Scholar
  18. Krohne TU, Allam JP, Novak N, Holz FG (2016) “Iodine allergy”: a medical myth with risks for the ophthalmological patient. Ophthalmologe 113:1023–1028CrossRefPubMedGoogle Scholar
  19. Kumar S, Medeiros F, Dowdy SC et al (2012) A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol. 127:525–531CrossRefPubMedGoogle Scholar
  20. Kumar S, Podratz KC, Bakkum-Gamez JN et al (2014) Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol 132:38–43CrossRefPubMedGoogle Scholar
  21. Laufer J, Scasso S, Papadia A et al (2013) Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer. Int J Gynaecol Obstet 123:142–145CrossRefPubMedGoogle Scholar
  22. Morotti M, Menada MV, Moioli M et al (2012) Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecol Oncol 125:536–540CrossRefPubMedGoogle Scholar
  23. Naoura I, Canlorbe G, Bendifallah S et al (2015) Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer. Gynecol Oncol 136:60–64CrossRefPubMedGoogle Scholar
  24. NCCN (2014) NCCN Clinical Practice Guidelines in Oncology. Uterine Neoplasms. Version 2.2014. http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf
  25. Papadia A, Azioni G, Brusacà B et al (2009) Frozen section underestimates the need for surgical staging in endometrial cancer patients. Int J Gynecol Cancer 19:1570–1573CrossRefPubMedGoogle Scholar
  26. Papadia A, Imboden S, Siegenthaler F et al (2016a) Laparoscopic Indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol 23:2206–2211CrossRefPubMedPubMedCentralGoogle Scholar
  27. Papadia A, Imboden S, Gasparri ML et al (2016b) Endometrial and cervical cancer patients with multiple sentinel lymph nodes at laparoscopic ICG mapping: How many are enough? J Cancer Res Clin Oncol 142:1831–1836CrossRefPubMedGoogle Scholar
  28. Papadia A, Gasparri ML, Siegenthaler F et al (2017a) FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem? J Cancer Res Clin Oncol 143:491–497CrossRefPubMedGoogle Scholar
  29. Papadia A, Gasparri ML, Buda A et al (2017b) Are allergic reactions to indocyaninegreen really that uncommon? A single institution experience. Obstet Gynecol Rep 1:1–2CrossRefGoogle Scholar
  30. Papadia A, Zapardiel I, Bussi B et al (2017c) Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99m with blue dye versus indocyanine green fluorescent dye. J Cancer Res Clin Oncol 143:475–480CrossRefPubMedGoogle Scholar
  31. Papadia A, Gasparri ML, Buda A et al (2017d) Sentinel lymph node mapping in endometrial cancer: comparison of fluorescence dye with traditional radiocolloid and blue. J Cancer Res Clin Oncol 143:2039–2048CrossRefPubMedGoogle Scholar
  32. Papadia A, Zapardiel I, Bussi B, Ghezzi F, Ceccaroni M, De Ponti E, Elisei F, Imboden S, de la Noval BD, Gasparri ML, Di Martino G, De Santiago J, Mueller M, Vecchione F, Dell’Orto F, Buda A (2017e) Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99(m) with blue dye versus indocyanine green fluorescent dye. J Cancer Res Clin Oncol 143:475–480CrossRefPubMedGoogle Scholar
  33. Rossi EC, Kowalski LD, Scalici J et al (2017) A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 18:384–392CrossRefPubMedGoogle Scholar
  34. Ruscito I, Gasparri ML, Braicu EI et al (2016) Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes—a meta-analysis. Ann Surg Oncol 23:3749–3756CrossRefPubMedGoogle Scholar
  35. Sala P, Morotti M, Menada MV et al (2014) Intraoperative frozen section risk assessment accurately tailors the surgical staging in patients affected by early-stage endometrial cancer: the application of 2 different risk algorithms. Int J Gynecol Cancer 24:1021–1026CrossRefPubMedGoogle Scholar
  36. Sinno AK, Fader AN, Roche KL et al (2014) A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol 134:281–286CrossRefPubMedGoogle Scholar
  37. Sinno AK, Peijnenburg E, Fader AN et al (2016) Reducing overtreatment: A comparison of lymph node assessment strategies for endometrial cancer. Gynecol Oncol 143:281–286CrossRefPubMedGoogle Scholar
  38. Soliman PT, Westin SN, Dioun S et al (2017) A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol 146:234–239CrossRefPubMedPubMedCentralGoogle Scholar
  39. Tanner EJ, Sinno AK, Stone RL et al (2015) Factors associated with successful bilateral sentinel lymph node mapping in endometrial cancer. Gynecol Oncol 138:542–547CrossRefPubMedGoogle Scholar
  40. Touhami O, Grégoire J, Renaud MC et al (2017) Performance of sentinel lymph node (SLN) mapping in high-risk endometrial cancer. Gynecol Oncol 147:549–553CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity Hospital of Berne and University of BerneBernSwitzerland
  2. 2.Dipartimento Assistenziale Integrato Ostetricia e Ginecologia, Perinatologia e Puericultura“Sapienza” University of RomeRomeItaly
  3. 3.Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital“Sapienza” University of RomeRomeItaly
  4. 4.Institute of PathologyUniversity of BernBernSwitzerland

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