Skip to main content
SpringerLink
Log in

ICG-Based Sentinel Lymph Node Biopsy in Endometrioid Endometrial Carcinoma—Results of a Prospective Study from a Single Tertiary Cancer Center of India

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

Abstract

Study Objective

Lymphadenectomy is the most accurate method of assessment of lymph node involvement in carcinoma endometrium. The benefit of lymphadenectomy in endometrial cancer is still unproven. Sentinel lymph node (SLN) evaluation is of growing importance because of less morbidity and good diagnostic accuracy. Identification rates, sensitivity, specificity, negative predictive value and positive predictive value of SLNB in comparison with standard pelvic with/without para-aortic lymph node dissection were analyzed in present study.

Methodology

Intraoperatively Indocyanine Green (ICG) tracer is injected into the cervix at 3’o clock and 9’o clock position at a concentration of 0.5 mg/ml. Sentinel lymph nodes were traced with the help of near-infrared spectrum supported camera technology (SPIES Camera-Karl Storz/Stryker ICG 4 K camera) by laparoscopy. These SLNs were identified, dissected and evaluated separately for metastasis. Complete pelvic with/without para-aortic lymphadenectomy was done and compared with results of SLNB.

Main Results

Eighty-six patients of endometrioid endometrial carcinoma were analyzed from June 2017 to December 2020 at a single tertiary cancer center in India. 88.4% (76/86) had at least one sentinel lymph node traced. Nodal metastasis was found in 8.1% (7/86) patients. SLNB identified metastasis in 5/7 (71% sensitivity). The specificity and negative predictive value (NPV) of SLNB were 100% (97/97) and 98.9% (97/98), respectively. False negative rate was < 1% (1/101).

Conclusion

Laparoscopic sentinel lymph node biopsy (SLNB) with ICG is an acceptable method of staging of lymph nodes in endometrioid endometrial carcinoma with accuracy comparable to standard lymphadenectomy. It has a good specificity, NPV and acceptable false negative rate compared to standard lymphadenectomy.

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
Fig. 5

Similar content being viewed by others

References

  1. Ferlay J, Steliaova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403.

    Article  CAS  Google Scholar 

  2. https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf

  3. McPherson CP, Sellers TA, Potter JD, et al. Reproductive factors and risk of endometrial cancer. The Iowa Women’s Health Study. Am J Epidemiol. 1996;143:1195–202.

    Article  CAS  Google Scholar 

  4. Hamilton CA, Cheung MK, Osann K, Chen L, et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006;94:642–6.

    Article  CAS  Google Scholar 

  5. Slomovitz BM, Burke TW, Eifel PJ, Ramondetta LM, Silva EG, Jhingran A, et al. Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases. Gynecol Oncol. 2003;91:463–9.

    Article  Google Scholar 

  6. Thomas M, Mariani A, Wright JD, Madarek EO, Powell MA, Mutch DG, et al. Surgical management and adjuvant therapy for patients with uterine clear cell carcinoma: a multiinstitutional review. Gynecol Oncol. 2008;108:293–7.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. Burbos N, Musonda P, Duncan TJ, et al. Estimating the risk of endometrial cancer in symptomatic postmenopausal women: a novel clinical prediction model based on patients’ characteristics. Int J Gynecol Cancer. 2011;21:500–6.

    Article  Google Scholar 

  9. Selman TJ, Mann C, Zamora J, Appleyard TL, Khan K. Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis. Can Med Assoc J. 2008;178(7):855–62.

    Article  Google Scholar 

  10. Papadia A, Zapardiel I, Bussi B, Ghezzi F, Ceccaroni M, De Ponti E, et al. Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc-99m with blue dye versus indocyanine green fluorescent dye. J Cancer Res Clin Oncol. 2017;143(3):475–80.

    Article  CAS  Google Scholar 

  11. Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database of Systematic Reviews 2017, Issue 10. DOI: https://doi.org/10.1002/14651858.CD007585. pub4

  12. Agar N, Philippe AC, Bourdel N, Rabischong B, Canis M, Le Bouedec G, et al. Morbidity of pelvic lymphadenectomy and para-aortic lymphadenectomy in endometrial cancer. Bull Cancer. 2015;102(5):428–35.

    Article  Google Scholar 

  13. Biglia N, Librino A, Ottino MC, Panuccio E, Daniele A, Chahin A. Lower limb lymphedema and neurological complications after lymphadenectomy for gynecological cancer. Int J Gynecol Cancer. 2015;25(3):521–5.

    Article  Google Scholar 

  14. Zikan M, Fischerova D, Pinkavova I, Slama J, Weinberger V, Dusek L, et al. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol. 2015;137(2):291–8.

    Article  Google Scholar 

  15. van de Poll-Franse LV, Pijnenborg JM, Boll D, Vos MC, van den Berg H, Lybeert ML, et al. Health related quality of life and symptoms after pelvic lymphadenectomy or radiotherapy vs. no adjuvant regional treatment in early stage endometrial carcinoma: a large population-based study. Gynecol Oncol. 2012;127(1):153–60.

    Article  Google Scholar 

  16. S. Kang et al./Gynecologic Oncology 123 (2011) 522–527 (meta-analysis based on 26 eligible studies, which included 1101 SLN procedures).

  17. Lawrie TA, Patel A, Martin-Hirsch PPL, Bryant A, Ratnavelu NDG, Naik R, et al. Sentinel node assessment for diagnosis of groin lymph node involvement in vulval cancer. Cochrane Database of Systematic Reviews 2014, Issue 6. DOI: https://doi.org/10.1002/14651858.CD010409.pub2.

  18. Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365–83.

    Article  Google Scholar 

  19. Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609.

    Article  Google Scholar 

  20. Geppert, et al., Sentinel lymph node biopsy in endometrial cancer—Feasibility, safety and lymphatic complications, Gynecol Oncol (2017)

  21. Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicenter, prospective, cohort study. Lancet Oncol. 2017; 18(3):384–92.https://doi.org/10.1016/S1470-2045 (17)30068–2.

  22. Ballester M, Dubernard G, Lécuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicenter study (SENTI-ENDO). Lancet Oncol. 2011;12:469–76 ([PubMed: 21489874]).

    Article  Google Scholar 

  23. Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216:459-76.e10.

    Article  Google Scholar 

  24. Frumovitz M, Plante M, Lee PS, Sandadi S, Lilja JF, Escobar PF, Gien LT, Urbauer DL, Abu-Rustum NR. Near-infrared fluorescence for detection of sentinel lymph nodes in women with cervical and uterine cancers (FILM): a randomised, phase 3, multicenter, non-inferiority trial. Lancet Oncol. 2018;19:1394–403.

    Article  Google Scholar 

  25. Papadia A, Imboden S, Siegenthale F, Gasparri ML. Laparoscopic indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol. 2016;23:2206–11. https://doi.org/10.1245/s10434-016-5090-x).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rocha A, Dominguez AM, Lecuru F, Bourdel N. Indocyanine green and infrared fluorescence in detection of sentinel lymph nodes in endometrial and cervical cancer staging—a systematic review. Euro J Obstetrics Gynecol Reprod Biol. 2016;206:213–9. https://doi.org/10.1016/j.ejogrb.2016.09.027.

    Article  CAS  Google Scholar 

  27. Eriksson AG, Montovano M, Beavis A, Soslow RA, Zhou Q, Abu-Rustum NR, et al. Impact of obesity on sentinel lymph node mapping in patients with newly diagnosed uterine cancer undergoing robotic surgery. Ann Surg Oncol. 2016;23(8):2522–8.

    Article  Google Scholar 

  28. Somashekhar SP, Arvind R, Kumar CR, Ahuja V, Ashwin KR. Sentinel node mapping using indocyanine green and near-infrared fluorescence imaging technology for endometrial cancer: A prospective study using a surgical algorithm in Indian patients. J Min Access Surg 0; 0: 0. DOI: https://doi.org/10.4103/jmas.JMAS_154_20

  29. Anupama Rajanbabu*, Reshu Agarwal. A prospective evaluation of the sentinel node mapping algorithm in endometrial cancer and correlation of its performance against endometrial cancer risk subtypes; Euro J Obstetrics Gynecol Reprod Biol. 224 (2018) 77–80; https://doi.org/10.1016/j.ejogrb.2018.03.017

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Basavatarakam Indo American Hospital and Research Institute, Hyderabad, Telangana, 500034, India

    B. Madhunarayana, S. C. Patnaik, K. V. V. N. Raju & T. Subramanyeshwar Rao

  2. Division of Gynecologic Oncology, Department of Surgical Oncology, Basavatarakam Indo American Hospital and Research Institute, Hyderabad, Telangana, 500034, India

    R. Rajagopalan Iyer

  3. Department of Pathology, Basavatarakam Indo American Hospital and Research Institute, Hyderabad, Telangana, 500034, India

    Sudha S. Murthy & Suseela Kodandapani

Authors
  1. B. Madhunarayana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Rajagopalan Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. C. Patnaik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. V. V. N. Raju
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sudha S. Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suseela Kodandapani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Subramanyeshwar Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Rajagopalan Iyer.

Ethics declarations

Conflict of interest

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madhunarayana, B., Rajagopalan Iyer, R., Patnaik, S.C. et al. ICG-Based Sentinel Lymph Node Biopsy in Endometrioid Endometrial Carcinoma—Results of a Prospective Study from a Single Tertiary Cancer Center of India. Indian J Gynecol Oncolog 19, 89 (2021). https://doi.org/10.1007/s40944-021-00586-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-021-00586-w

Keywords

Search

Navigation