Sentinel Node Mapping in Endometrial Cancer Using Hysteroscopic Injection of Indocyanine Green and Near-Infrared Fluorescence Imaging

Abstract

<h3>Study Objective</h3> To report on the performance of hysteroscopic injection of indocyanine green (ICG) for sentinel lymph node mapping (SNM) in endometrial cancer. <h3>Design</h3> This is a retrospective cohort study of consecutive patients who had SNM via hysteroscopic injection of IGC. Detection rate, accuracy, and oncologic outcomes were evaluated. <h3>Setting</h3> Cancer center. <h3>Patients or Participants</h3> Consecutive patients with apparent early-stage endometrial cancer. <h3>Interventions</h3> Laparoscopic staging including hysterectomy, bilateral salpingo-oophorectomy, and SNM. SNM was performed using a hysteroscopic injection of IGC and near-infrared fluorescence imaging (Video). <h3>Measurements and Main Results</h3> Chart of 52 patients were evaluated. At least one sentinel node was detected in 95% of patients. Bilateral pelvic mapping was found in 74% of cases. In 45% of cases, SLNs mapped in both pelvic and para-aortic nodes, and four cases (8%) in the para-aortic area, only. In three patients (6%) sentinel nodes were found in aberrant (parametrial/presacral) areas. Seven (13.5%) patients were diagnosed with nodal involvement. Low volume disease was observed in four (8%) patients (2 with isolated tumor cells and 2 with micrometastasis). After a median (range) follow-up of 34.7 (10, 61) months, five (9.6%) patients developed recurrences: two abdominal/distant, one vaginal, and one nodal (in the para-aortic area in a patient diagnosed with endometrioid G1 endometrial cancer and isolated tumor cells in a pelvic node). No patient died of disease. <h3>Conclusion</h3> Hysteroscopic injection of ICG ensures delineation of lymphatic drainage from the tumor area, thus achieving accurate detection of sentinel nodes. Further evidence is warranted to assess the role of hysteroscopic injection in identifying extrapelvic sentinel nodes.