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A Prospective Cohort Study Comparing Colorimetric and Fluorescent Imaging for Sentinel Lymph Node Mapping in Endometrial Cancer

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

Abstract

Background

This prospective cohort study aimed to assess sentinel lymph node (SLN) mapping using isosulfan blue (ISB) compared with ISB plus indocyanine green (ICG) and near-infrared imaging (NIR) for patients with endometrial cancer.

Methods

In this study, 200 patients with endometrial cancer underwent SLN assessments and were randomized to ISB + ICG (n = 180) or ISB alone (n = 20). Blue dye determinations were recorded for all 200 cases followed by NIR imaging of ICG for 180 randomized subjects. All the patients underwent robotically assisted hysterectomy with pelvic ± aortic lymphadenectomy.

Results

The mean age of the patients was 64.5 ± 8.4 years, and the mean body mass index (BMI) was 33 ± 7.6 kg/m2. The histologies were endometrioid G1 (43%), G2 (30%), G3 (7%), and type 2 (20%). The mean time from dye injection to initiation of mapping was 13.4 ± 6.2 min, and the time to removal of SLN was 17.4 ± 11.2 min. Detection of SLN for the 20 ISB control cases did not differ from that for the 180 ISB + ICG cases (p > 0.05). The rates of SLN detection for ISB + ICG/NIR (n = 180) versus ISB (n = 200) were as follows: bilateral (83.9 vs. 40%), unilateral (12.2 vs. 36%), and none (3.9 vs. 24%) (p < 0.001). The median SLN per case was 2 (range 0–4). Positive SLNs were found in 21.1% (n = 38) of the ISB + ICG cases compared with 13.5% (n = 27) of the ISB cases (p = 0.056). The false-negative rate for SLN biopsy was 2.5% (95% confidence interval, 0.1–14.7%). In 61% (25/41) of the node-positive cases, SLN was the only positive lymph node (LN). Isolated tumor cells were found in 39.5% (15/38) of the SLN metastasis cases compared with 26.7% (4/15) of the non-SLN metastasis cases (p = 0.528).

Conclusions

In this prospective study, ISB + ICG and NIR detected more SLNs and more LN metastases than ISB alone. Assessment of SLN with ICG + ISB/NIR imaging had excellent sensitivity for detection of metastasis and no safety issues.

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Disclosure

Dr. Robert W. Holloway has received compensation for advanced training programs from Intuitive Surgical, Inc., Sunnyvale, CA. All the other authors declare no conflict of interest.

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Authors and Affiliations

  1. Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA

    Robert W. Holloway MD, Sarfraz Ahmad PhD, James E. Kendrick MD, Glenn E. Bigsby DO, Lorna A. Brudie DO, Giselle B. Ghurani MD, Nicole M. Stavitzski BS, Jasmine L. Gise BS, Susan B. Ingersoll PhD & Julie W. Pepe PhD

Authors
  1. Robert W. Holloway MD
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  2. Sarfraz Ahmad PhD
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  3. James E. Kendrick MD
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  4. Glenn E. Bigsby DO
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  5. Lorna A. Brudie DO
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  6. Giselle B. Ghurani MD
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  7. Nicole M. Stavitzski BS
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  8. Jasmine L. Gise BS
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  9. Susan B. Ingersoll PhD
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  10. Julie W. Pepe PhD
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Corresponding authors

Correspondence to Robert W. Holloway MD or Sarfraz Ahmad PhD.

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Holloway, R.W., Ahmad, S., Kendrick, J.E. et al. A Prospective Cohort Study Comparing Colorimetric and Fluorescent Imaging for Sentinel Lymph Node Mapping in Endometrial Cancer. Ann Surg Oncol 24, 1972–1979 (2017). https://doi.org/10.1245/s10434-017-5825-3

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  • DOI: https://doi.org/10.1245/s10434-017-5825-3

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