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Annals of Surgical Oncology

, Volume 23, Issue 11, pp 3749–3756 | Cite as

Sentinel Node Mapping in Cervical and Endometrial Cancer: Indocyanine Green Versus Other Conventional Dyes—A Meta-Analysis

  • Ilary Ruscito
  • Maria Luisa Gasparri
  • Elena Ioana Braicu
  • Filippo Bellati
  • Luigi Raio
  • Jalid Sehouli
  • Michael D. Mueller
  • Pierluigi Benedetti Panici
  • Andrea Papadia
Gynecologic Oncology

Abstract

Background

Historically, blue dyes, 99Tc or a combination of the two tracers have been used for sentinel lymph node (SLN) mapping in cervical and endometrial cancer patients. Indocyanine green (ICG), as a tracer, has been recently introduced in this setting. Our goal was to assess the differences in overall and bilateral detection rates as well as in false-negative rates among the different tracers.

Methods

The electronic databases PubMed, MEDLINE, and Scopus were searched in January 2016 by searching the terms “sentinel lymph node” and “dye” and “indocyanine green,” and “cervical cancer” or “endometrial cancer.” Series comparing different tracers injected intracervically and reporting the detection rate and/or SLN false-negative rate were selected.

Results

Forty-five studies were retrieved. Six studies including 538 patients met selection criteria. Compared with blue dyes, ICG SLN mapping had higher overall (odds ratio [OR] 0.27; 95 % confidence interval [CI] 0.15–0.50; p < 0.0001) and bilateral detection rates (OR 0.27; 95 % CI 0.19–0.40; p < 0.00001). No differences were found between ICG and 99TC, although these results are based on data of a single series. No differences in overall and bilateral detection rates were found between ICG and the combination of blue dyes and 99TC. The pooled analysis of false-negative rates data showed no difference in false-negative rates between tracers.

Conclusions

In cervical and endometrial cancer, ICG SLN mapping seems to be equivalent to the combination of blue dyes and 99TC in terms of overall and bilateral detection rates. Its safety profile and ease of use may favor its employment respect to conventional tracers.

Keywords

Sentinel Lymph Node Endometrial Cancer Sentinel Lymph Node Biopsy Sentinel Lymph Node Mapping Endometrial Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

All authors declare no conflict of interest.

References

  1. 1.
    Dargent D, Martin X, Mathevet P. Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer. Gynecol Oncol. 2000;79:411–5.CrossRefPubMedGoogle Scholar
  2. 2.
  3. 3.
  4. 4.
    Cormier B, Diaz JP, Shih K, et al. Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer. Gynecol Oncol. 2011;122:275–80.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Barlin JN, Khoury-Collado F, Kim CH, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125:531–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Flower RW. Injection technique for indocyanine green and sodium fluorescein dye angiography of the eye. Invest Ophthal. 1973;12:881–95.PubMedGoogle Scholar
  7. 7.
    Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Rossi EC, Ivanova A, Boggess JF. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study. Gynecol Oncol. 2012;124:78–82.CrossRefPubMedGoogle Scholar
  9. 9.
    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;133:274–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Sinno AK, Fader AN, Roche KL, Giuntoli RL 2nd, Tanner EJ. A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol. 2014;134:281–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Plante M, Touhami O, Trinh XB, Renaud MC, 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;137:443–7.CrossRefPubMedGoogle Scholar
  12. 12.
    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;137:436–42.CrossRefPubMedGoogle Scholar
  13. 13.
    Imboden S, Papadia A, Nauwerk M, et al. A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol. 2015;22:4198–203.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kataoka F, Susumu N, Yamagami W, et al. The importance of para-aortic lymph nodes in sentinel lymph node mapping for endometrial cancer by using hysteroscopic radio-isotope tracer injection combined with subserosal dye injection: prospective study. Gynecol Oncol. doi: 10.1016/j.ygyno.2015.12.023.PubMedGoogle Scholar
  15. 15.
    Buda A, Di Martino G, Vecchione F, et al. Optimizing strategies for sentinel lymph node mapping in early-stage cervical and endometrial cancer: comparison of real-time fluorescence with indocyanine green and Methylene blue. Int J Gynecol Cancer. 2015;25:1513–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Buda A, Crivellaro C, Elisei F, et al. Impact of indocyanine green for sentinel lymph node mapping in early stage endometrial and cervical cancer: comparison with conventional radiotracer 99mTc and/or blue dye. Ann Surg Oncol. doi: 10.1245/s10434-015-5022-1 PubMedPubMedCentralGoogle Scholar
  17. 17.
    Holloway RW, Bravo RA, Rakowski JA, James JA, Jeppson CN, Ingersoll SB, Ahmad S. Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: a comparison of colorimetric and fluorescence imaging. Gynecol Oncol. 2012;126:25–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Tanner EJ, Sinno AK, Stone RL, Levinson KL, Long KC, Fader AN. Factors associated with successful bilateral sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015;138:542–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Holman LL, Levenback CF, Frumovitz M. Sentinel lymph node evaluation in women with cervical cancer. J Minim Invasive Gynecol. 2014;21:540–5.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Cormier B, Rozenholc AT, Gotlieb W, Plante M4, Giede C5; Communities of Practice (CoP) Group of Society of Gynecologic Oncology of Canada (GOC). Sentinel lymph node procedure in endometrial cancer: a systematic review and proposal for standardization of future research. Gynecol Oncol. 2015;138:478–85.CrossRefPubMedGoogle Scholar
  21. 21.
    Altgassen C, Hertel H, Brandstädt A, Köhler C, Dürst M, Schneider A; AGO Study Group. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol. 2008;26:2943–51.CrossRefPubMedGoogle Scholar
  22. 22.
    van de Lande J, Torrenga B, Raijmakers PG, Hoekstra OS, van Baal MW, Brölmann HA, Verheijen RH. Sentinel lymph node detection in early stage uterine cervix carcinoma: a systematic review. Gynecol Oncol. 2007;106:604–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Papadia A, Imboden S, Siegenthaler F, Gasparri ML, Mohr S, Lanz S, Mueller MD. Laparoscopic indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol. 2016:1–6Google Scholar
  24. 24.
    Conte M, Panici PB, Guariglia L, Scambia G, Greggi S, Mancuso S. Pelvic lymphocele following radical para-aortic and pelvic lymphadenectomy for cervical carcinoma: incidence rate and percutaneous management. Obstet Gynecol. 1990;76:268–71.PubMedGoogle Scholar
  25. 25.
    Papadia A, Imboden S, Fink A, Gasparri ML, Bolla D, Mueller MD. Accuracy of sentinel lymph node mapping after previous hysterectomy in patients with occult cervical cancer. Ann Surg Oncol. 2016:1–7Google Scholar
  26. 26.
    Lécuru F, Mathevet P, Querleu D, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29:1686–91.CrossRefPubMedGoogle Scholar
  27. 27.
    Niikura H, Kaiho-Sakuma M, Tokunaga H, Toyoshima M, Utsunomiya H, Nagase S, et al. Tracer injection sites and combinations for sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2013;131:299–303.CrossRefPubMedGoogle Scholar
  28. 28.
    Ditto A, Martinelli F, Bogani G, Papadia A, Lorusso D, Raspagliesi F. Sentinel node mapping using hysteroscopic injection of indocyanine green and laparoscopic near-infrared fluorescence imaging in endometrial cancer staging. J Minim Invasive Gynecol. 2015;22(1):132–3.CrossRefPubMedGoogle Scholar
  29. 29.
    Kumar S, Podratz KC, Bakkum-Gamez JN, et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol. 2014;132(1):38–43.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Ilary Ruscito
    • 1
    • 2
  • Maria Luisa Gasparri
    • 3
    • 1
  • Elena Ioana Braicu
    • 2
  • Filippo Bellati
    • 4
  • Luigi Raio
    • 3
  • Jalid Sehouli
    • 2
  • Michael D. Mueller
    • 3
  • Pierluigi Benedetti Panici
    • 1
  • Andrea Papadia
    • 3
  1. 1.Department of Gynecology, Obstetrics and UrologySapienza University of RomeRomeItaly
  2. 2.Department of GynecologyCampus Virchow Clinic, Charité Medical UniversityBerlinGermany
  3. 3.Department of Obstetrics and GynecologyUniversity Hospital of Berne and University of BerneBerneSwitzerland
  4. 4.Department of Medical and Surgical Sciences and Translational MedicineSapienza University of Rome, S. Andrea HospitalRomeItaly

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