Skip to main content
SpringerLink
Log in

From Conventional Radiotracer Tc-99m 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

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99m) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG).

Methods

Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99m with BD.

Results

Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99m with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99m with BD; this difference was statistically significant (p < 0.0001).

Conclusions

The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.

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

Similar content being viewed by others

References

  1. Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137:351–61.

    Article  PubMed  Google Scholar 

  2. van de Lande J, Torrenga B, Raijmakers PG, et al. Sentinel lymph node detection in early stage uterine cervix carcinoma: a systematic review. Gynecol Oncol. 2007;106:604–13.

    Article  PubMed  Google Scholar 

  3. Bats AS, Frati A, Mathevet P, et al. Contribution of lymphoscintigraphy to intraoperative sentinel lymph node detection in early cervical cancer: analysis of prospective multicenter SENTICOL cohort. Gynecol Oncol. 2015;137:134–9.

    Article  Google Scholar 

  4. Reinhart MB, Huntington CR, Blair LJ, Heniford BT, Augenstein VA. Indocyanine green: historical context, current applications, and future consideration. Surg Innov. 2016;23:166–75.

    Article  PubMed  Google Scholar 

  5. Wada H, Hyun H, Vargas C, et al. Sentinel lymph node mapping of liver. Ann Surg Oncol. 2015;22:1147–55.

    Article  Google Scholar 

  6. Sugie T, Kinoshita T, Masuda N, et al. Evaluation of the clinical utility of the ICG fluorescence method compared with the radioisotope method for sentinel lymph node biopsy in breast cancer. Ann Surg Oncol. 2016;23:44–50.

    Article  PubMed  Google Scholar 

  7. Bats AS, Mathevet P, Buenerd A, et al. The sentinel node technique detects unexpected drainage pathways and allows nodal ultrastaging in early cervical cancer: insights from the multicenter prospective SENTICOL study. Ann Surg Oncol. 2013;20:413–22.

    Article  PubMed  Google Scholar 

  8. Horn LC, Einenkel J, Hockel M, et al. Recommendations for the handling and oncologic pathology report of lymph node specimens submitted for evaluation of metastatic disease in gynecologic malignancies. Pathologe. 2005;26:266–72.

    Article  PubMed  Google Scholar 

  9. National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Version 2.2015. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

  10. Koh WJ, Greer BE, Abu-Rustum NR, et al. Cervical cancer, version 2.2015. Featured updates to the NCCN guideline. JNCCN. 2015;13:395–404.

    CAS  PubMed  Google Scholar 

  11. 11. 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.

    Article  PubMed  Google Scholar 

  12. Cibula D, Oonk MHM, Abu Rustum NR. Sentinel node biopsy in the management of gynecologic cancer. Curr Opin Obstet Gynecol. 2015;27:66–72.

    Article  PubMed  Google Scholar 

  13. Kadkhodayan S, Hasanzadeh M, Treglia G, et al. Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature. Eur J Surg Oncol. 2015;41:1–20.

    Article  CAS  PubMed  Google Scholar 

  14. Lecuru 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.

    Article  PubMed  Google Scholar 

  15. Cibula D, Abu-Rustum NR, Dusek L, et al. Bilateral ultrastaging of sentinel lymph node in cervical cancer: lowering the false-negative rate and improving the detection of micrometastasis. Gynecol Oncol. 2012;127:462–6.

    Article  PubMed  Google Scholar 

  16. Cibula D, Abu-Rustum NR, Dusek L, et al. Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol. 2012;124:496–501.

    Article  CAS  PubMed  Google Scholar 

  17. Furukawa N, Oi H, Yoshida S, Shigetomi H, Kanayama S, Kobayashi H. The usefulness of photodynamic eye for sentinel lymph node identification in patients with cervical cancer. Tumori. 2010;96:936–40.

    PubMed  Google Scholar 

  18. 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;1:78–82.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Plante M, Touhami O, Trinh XB, et al. 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.

    Article  PubMed  Google Scholar 

  21. Imboden S, Papadia A, Nauwerk M, et al. A comparison of radiocolloid and indocyanine green fluorescent imaging sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol. 2015;22:4198–203.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Buda A, Crivellaro C, Elisei F, et al. Impact of indocyanine green (ICG) for sentinel node mapping in early stage endometrial and cervical cancer: comparison with conventional radiotracer Tc-99m and/or blue dye. Ann Surg Oncol. 2015. doi:10.1245/s10434-015-5022-1.

  23. Khoury-Collado F, Glaser GE, Zivanovic O, et al. Improving sentinel node detection rate in endometrial cancer: how many cases are needed? Gynecol Oncol. 2009;115:453–5.

    Article  PubMed  Google Scholar 

  24. Gurtzacuzan L, Jimenez W, Nofechmozes S, et al. Sentinel lymph node biospy vs lymphadenectomy in early stage cervical cancer: is it time to change the gold standard? Gynecol Oncol. 2010;116:28–32.

    Article  Google Scholar 

  25. 25. Schiavone MB, Zivanovic O, Zhou Q, et al. Survival of patients with uterine carcinosarcoma undergoing sentinel lymph node mapping. Ann Surg Oncol. 2016;23:196–202.

    Article  PubMed  Google Scholar 

  26. St Clair CM, Erikkson AG, Ducie GA, et al. Low-volume lymph nodes metastasis discovered during sentinel lymph node mapping for endometrial cancer. Ann Surg. 2016;23:1653–9.

    Article  Google Scholar 

  27. Ercoli A, Dalmas V, Iannone V, et al. The lymphatic drainage of the uterine cervix in adult fresh cadavers: anatomy and surgical implications. Eur J Surg Oncol. 2010;36:298–303.

    Article  CAS  PubMed  Google Scholar 

  28. Papadia A, Imboden S, Siegenthaler F, et al. Laparoscopic indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol. 2016. doi:10.1245/s10434-016-5090-x.

  29. Daric MC, Gomez-Hidalgo MR, Westin SN, et al. Role of indocyanine green in sentinel node mapping in gynecologic cancer: is fluorescence imaging the new standard? J Min Inv Gynecol. 2016;23:186–93.

    Article  Google Scholar 

  30. Ghezzi F, Casarin J, Uccella S. Mini-laparoscopic sentinel node detection in endometrial cancer: further reducing invasiveness for patients with early stage disease. Ann Surg Oncol. 2015;22(Suppl 3):342.

    Article  Google Scholar 

Download references

Acknowledgment

The authors thank Patricia Ann Sawchuk for her contributions to the article’s revision.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy

    Alessandro Buda MD, Andrea Alberto Lissoni MD, Debora Verri MD, Beatrice Bussi MD & Giampaolo Di Martino MD

  2. Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland

    Andrea Papadia MD, PhD, Sara Imboden MD, Maria Luisa Gasparri MD & Michael Mueller MD

  3. Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain

    Ignacio Zapardiel MD, PhD, Maria Dolores Diestro MD & Begoña Diaz de la Noval MD

  4. Department of Oncological Surgery, Gynecologic Oncologic Unit, “Regina Elena” National Cancer Institute, Rome, Italy

    Enrico Vizza MD

  5. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy

    Fabio Ghezzi MD

  6. Department of Medical Physics, San Gerardo Hospital, Monza, Italy

    Elena De Ponti MD

  7. Technomed Foundation, University of Milano-Bicocca, Monza, Italy

    Cinzia Crivellaro MD

Authors
  1. Alessandro Buda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Papadia MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ignacio Zapardiel MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enrico Vizza MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Ghezzi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elena De Ponti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea Alberto Lissoni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sara Imboden MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Dolores Diestro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Debora Verri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Maria Luisa Gasparri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Beatrice Bussi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Giampaolo Di Martino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Begoña Diaz de la Noval MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Michael Mueller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Cinzia Crivellaro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Buda MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buda, A., Papadia, A., Zapardiel, I. et al. From Conventional Radiotracer Tc-99m 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, 2959–2965 (2016). https://doi.org/10.1245/s10434-016-5227-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5227-y

Keywords

Search

Navigation