Sentinel Lymph Node Detection Rate Research Articles

Sentinel lymph node mapping in early-stage cervical cancer: Meta-analysis.

Background:The value of sentinel lymph node (SLN) mapping for early-stage cervical cancer remains controversial. Therefore, we collected data to investigate the feasibility and diagnostic accuracy of SLN in patients with early-stage (IA-IIA) cervical cancer.Methods:We searched Embase, PubMed, and the Cochrane Library databases issued before June 1, 2020. The sample size of the selected study was at least 10 patients with early-stage (IA-IIA) cervical cancer, the pooled detection rates and the separate detection rate (overall detection rate, bilateral detection rate) using blue dye with Tc, technetium 99 (Tc) and indocyanine green (ICG) technique of early-stage cervical cancer was reported. R-3.6.1 software was used to evaluate pooled detection rate and sensitivity.Results:Two thousand one hundred sixty-four patients included for analysis in 28 studies ranging from 12 to 405 patients. The combined overall detection rate of SLN mapping was 95% with a 72% pooled bilateral detection rate. The sensitivity of the combined overall detection rate of SLN mapping was 94.99% as well as a sensitivity of 72.43% bilateral detection rate. The overall detection rate of SLN was 96% for blue dye with Tc, 95% for Tc, 98% for ICG technique. The bilateral detection rate of SLN was 76% for blue dye with Tc, 63% for Tc, 85% for ICG technique. The sensitivity of the overall detection rate of SLN mapping was 97.76% as well as a sensitivity of 84.96% bilateral detection rate of ICG technique.Conclusion:In early-stage cervical cancer, overall detection rate of SLN mapping is elevated while bilateral detection rate is lower. The overall detection rate (98%) as well as bilateral rate (85%) of ICG seems to be a better SLN mapping technique among the method of SLN mapping (using blue dye with Tc, Tc or ICG). We believe SLN mapping may be considered contemporary technique which could provide additional benefits over traditional pelvic lymphadenectomy. While promising results in SLN mapping has been found, larger patient samples, including randomized studies, are required at the same time.

Sentinel lymph node biopsy with carbon nanoparticle suspension after neoadjuvant chemotherapy for breast cancer patients.

The aim of the study was to explore the feasibility of performing sentinel lymph node biopsy (SLNB) using a carbon nanoparticle suspension (CNPS) after neoadjuvant chemotherapy in breast cancer patients. Some 152 patients diagnosed with primary breast cancer (cT1-3N0-2M0) were recruited. Patients were divided into two groups according to axillary lymph node (ALN) status after four to six cycles of neoadjuvant chemotherapy. All patients received a CNPS injection, after which SLNB and axillary lymph node dissection (ALND) were performed. Sentinel lymph nodes (SLN) of 143 patients were identified; with an accuracy rate of 94.4% and a false-negative rate of 9.9%. Group A included 67 patients, and the detection, accuracy and false-negative rates within this group were 95.5%, 96.9% and 6.7%, respectively. The corresponding rates for group B (85 patients) were 92.9%, 92.4% and 11.8%, respectively. CNPS is an ideal tracer for improving the detection rate of SLN and can be used to determine SLN status following neoadjuvant chemotherapy.

Sentinel lymph node biopsy in breast cancer after neoadjuvant therapy using a magnetic tracer versus standard technique: A multicentre comparative non-inferiority study (IMAGINE-II)

IntroductionPrevious studies have shown that a magnetic tracer technique using superparamagnetic iron oxide (SPIO) and a manual magnetometer (Sentimag, SM) is as effective as the standard technique using a radioisotope injection and a gamma probe (GP) for the detection of sentinel lymph nodes (SLNs) in breast cancer (BC) patients. This study was designed to investigate the performance of SM for post-neoadjuvant (NAT) SLN biopsy in BC patients. Materials and methodsPost-NAT BC patients were recruited from five centres. Readings of SLNs were recorded in transcutaneous, intraoperative and ex vivo scenarios by both GP and SM techniques. SLNs were assessed by OSNA (One-Step Nucleic Acid Amplification). ResultsA total of 89 patients were included. At the patient level, the transcutaneous and intraoperative SLN detection rate was 97.8% by both techniques. At the node level, the GP detection rate intraoperatively was lower than that of SM (93.8% vs. 99.2%), with a concordance rate of 93% (90% CI 1.25; 9.44). The ex vivo detection rate was lower for GP compared to SM both per patient 96.6% vs. 97.8%, and per node 90.6% vs. 98.4% (90% CI -2.03; 4.22 and 1.82; 13.68, respectively). Furthermore, the detection rate of pathologically positive SLNs per patient and per node was lower for GP than SM both intraoperatively and ex vivo. These results showed the non-inferiority of SM intraoperatively per node (90% CI -4.89; 20.89) and ex vivo per patient (90% CI -2.38; 29.66). ConclusionOur study showed the non-inferiority of SM compared to GP for detecting SLNs in post-NAT BC patients.

Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial.

Simple SummarySuperparamagnetic iron oxide nanoparticles (SPIO) have been shown to identify sentinel lymph nodes (SLNs) in patients with breast cancer. This study investigated whether a minimally invasive approach with MRI-LG after SPIO injection in the breast followed by a magnetic guided axillary ultrasound and core biopsy of the SLN (MagUS) could accurately stage the axilla. The study included not only patients planned for primary surgery but also patients with recurrent cancer after previous surgery, but also patients scheduled for neoadjuvant treatment (NAT). The latter underwent minimally invasive SLNB prior to treatment and had their SLN clipped; surgery in the axilla was performed after NAT. In 79 included patients, MagUS detected all patients with macrometastasis and performed comparably with surgical sentinel lymph node dissection (SLND). It also allowed for marking of the SLN in patients planned for PST and enabled tailored decision making in breast cancer recurrence.Lymph Node Dissection (SLND) is standard of care for diagnosing sentinel lymph node (SLN) status in patients with early breast cancer. Study aim was to determine whether the combination of Superparamagnetic iron oxide nanoparticles (SPIO) MRI-lymphography (MRI-LG) and a Magnetic-guided Axillary UltraSound (MagUS) with biopsy can allow for minimally invasive, axillary evaluation to de-escalate surgery. Patients were injected with 2 mL of SPIO and underwent MRI-LG for SN mapping. Thereafter MagUS and core needle biopsy (CNB) were performed. Patients planned for neoadjuvant treatment, the SLN was clipped and SLND was performed after neoadjuvant with the addition of isotope. During surgery, SLNs were controlled for signs of previous biopsy or clip. The primary endpoint was MagUS SLN detection rate, defined as successful SLN detection of at least one SLN of those retrieved in SLND. In 79 patients, 48 underwent upfront surgery, 12 received neoadjuvant and 19 had recurrent cancer. MagUS traced the SLN in all upfront and neoadjuvant cases, detecting all patients with macrometastases (n = 10). MagUS missed only one micrometastasis, outperforming baseline axillary ultrasound AUS (AUC: 0.950 vs. 0.508, p < 0.001) and showing no discordance to SLND (p = 1.000). MagUS provides the niche for minimally invasive axillary mapping that can reduce diagnostic surgery.

Sentinel lymph node mapping in breast cancer patients following neoadjuvant chemotherapy: systematic review and meta-analysis about head to head comparison of cN0 and cN + patients.

The effectiveness of sentinel lymph node (SLN) mapping and biopsy following neoadjuvant chemotherapy (NAC) in axillary lymph node staging of breast cancer (BCa) patients with initial clinical node positive status (cN +) compared to clinical node negative status (cN0) is not yet known. The aim of this meta-analysis was to compare the accuracy of SLN mapping following NAC in cN + and cN0 BCa patients. PubMed and Scopus were comprehensively reviewed to retrieve all the studies that performed SLN mapping/biopsy and standard axillary lymph node dissection on cN0 and cN + BCa patients following NAC. Pooled detection and false negative rates for N0 and N + patients including 95% confidence interval values (95% CI) were evaluated. Odds ratio (OR) and risk difference (RD) of SLN detection failure and false negative results were compared between two groups. A total of 27 articles were included for SLN detection rate evaluation and 17 for false negative assessment. The OR and RD of detection failure in N + group compared with N0 group following NAC were 2.22 (p = 0.00, 95% CI 1.4-3.4) and 4% (p = 0.00, 95% CI 2-6%), respectively. The OR and RD of false negative rate were 1.6 (p = 0.01, 95% CI 1-2.6) and 8% (p = 0.02, 95% CI 1-14%), respectively. SLN mapping in BCa patients following NAC shows high risk of detection failure and high false negative rate of SLN biopsy in cN + patients. In comparison with cN0 BCa patients, SLN mapping and biopsy after NAC was associated with almost two times higher odds of detection failure and false negative results in cN + patients; therefore, this method should not be recommended in this group of patients.

Evaluation of sentinel lymph node detection rates at increasing BMI

<h3>Objectives:</h3> Sentinel lymph node (SLN) mapping has become the preferred method for surgical staging of endometrial cancer; however, previous studies on SLN mapping have not reported detection rates specifically in terms of obesity class. Our objective was to evaluate the success of SLN detection in endometrial cancer as it relates to body mass index (BMI). <h3>Methods:</h3> Clinicopathologic data were abstracted for patients who completed surgical staging at a single institution between 2015 and 2020. All patients who completed sentinel lymph node mapping had cervical injection with ICG green and near infrared imaging via the robotic platform. Descriptive statistics were calculated, chi-square tests were used to assess the associations between categorical variables, and independent T tests were used for continuous variables. <h3>Results:</h3> A total of 337 patients completed surgical staging over the study period. Of these, 226 women completed cervical dye injection with attempted sentinel lymph node mapping. Two hundred and ten women (92.9%) women had at least a unilateral sentinel lymph node detected with 156 women (74.3%) mapping bilaterally. The majority of patients were obese, accounting for 65% of the study population with a mean BMI of 34.4 kg/m² (range 18.5 - 66.1kg/m²). Mean BMI at the time of surgery was significantly lower for patients with sentinel lymph nodes identified compared to those who did not successfully map correlating with class I versus class II obesity (34.1kg/m² vs 39.2kg/m², p=.02). Only two normal weight or overweight patients (2.6%) did not successfully map, while 28.5% of women with super morbid obesity (BMI>50kg/m²) did not map successfully. Of the super morbidly obese patients that mapped, only 3/7 (57.1%) mapped bilaterally. Patients that did not map had significantly longer procedure time by 35 minutes (192 vs 157 minutes, p<0.001) Eighteen patients (8%) had positive lymph nodes identified. There was no difference in rates of node positivity across weight class or by mean BMI. <h3>Conclusions:</h3> Patients with failed sentinel lymph node identification had a higher mean BMI and longer procedure time, with the highest rates of failed mapping found in super morbidly obese patients. The current results may aide in the selection of surgical staging methods and the preoperative counseling for patients, particularly those with BMI >50kg/m².

Lymphatic mapping and obesity with sentinel lymph node biopsy in endometrial cancer

<h3>Objectives:</h3> Sentinel lymph node biopsy (SLNB) has emerged as an acceptable alternative to complete pelvic and paraaortic lymph node dissection (PPALND) for patients with clinical stage I endometrial cancer. Several factors are associated with high risk of bilateral SLN detection failure. Our aim is to investigate the effect of obesity on bilateral SLN detection rates. <h3>Methods:</h3> Patients with either clinical stage I endometrial cancer or complex atypical hyperplasia were retrospectively reviewed from September 2016 through February 2020. All patients had undergone either a robot-assisted or laparoscopic hysterectomy with SLNB. Endometrioid, uterine papillary serous (UPSC), malignant mixed mesodermal tumor (MMMT), and clear cell (CC) histologies were included. Indocyanine green was injected into the cervix per our protocol. Patients with suboptimal lymph node mapping or nodes suspicious for metastasis underwent a side specific pelvic lymph node dissection (LND). In addition to SLNB, PPALND was performed for patients with UPSC, MMMT, and CC. Sentinel lymph nodes (SLN) were evaluated using ultra-staging protocols including serial sectioning and cytokeratin staining. The medical record was queried for successful bilateral or unilateral sentinel lymph node detection. Patient demographic data was then collected and analyzed with sentinel lymph node detection rate. <h3>Results:</h3> A total of 97 patients were reviewed and included: 92 had diagnosed endometrial cancer while 5 had complex atypical hyperplasia. Stage were as follows: 81 patients had stage I or II disease, and 8 patients had Stage III disease diagnosed at surgery. At least one SLN was detected 95.9% of cases, with an overall bilateral detection rate of 77.7%. In total, 53 patients classified as obese (25 Class I, 15 Class II and 13 Class III), 24 patients were overweight (BMI 25-29.9) and 20 patients had normal BMI. Unilateral and bilateral detection rates were not independently associated with obesity class. Bilateral SLN detection rates were 76% in normal BMI class and 67%, 83% and 73% for Class I, Class II and Class III obesity respectively; while at least one SLN was detected in 94% of normal BMI class and 92%, 96%, 100% and 92% in overweight weight class, Class I, II and II obesity respectively. <h3>Conclusions:</h3> Patient BMI is an important consideration for preoperative planning and success of bilateral sentinel lymph node mapping. Bilateral detection rates among obese patients are comparable to those of non-obese patients in our cohort. Despite previously reported correlation between BMI and successful bilateral mapping, our results do not demonstrate this relationship and obesity does not appear to be a contraindication to SLNB.

ICG/NIR TECHNIQUE IN LYMPH NODE MAPPING IN PATIENTS WITH COLORECTAL CANCER

Most cancers in humans are epithelial in nature and such neoplasms metastasize via lymphatics; therefore, the lymphatic system plays a pivotal role in a significant number of malignancies. The hematologic behavior of metastatic cancer has been extensively studied, but little is known regarding lymphatic metastasis. Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tumor. Detection and pathological examination of the SLN is an important oncological procedure that minimizes morbidity related to extensive nodal dissection. After many years of observation and research on its use in various malignancies SLN biopsy has become the standard surgical treatment in patients with malignant melanoma, breast and cervical cancers.&#x0D; Today, the issue of diagnosing lymphogenous metastasis in patients with colorectal cancer remains relevant. Standardized methods for examining lymph nodes do not allow to reliably establish the presence of their metastatic lesions. For a more effective assessment, additional examinations are carried out to identify the sentinel lymph node and its precision study, in particular, one of the newest methods is mapping of sentinel lymph nodes using Indocyanine Green (ICG) using near infrared radiation (NIR). Along with the introduction of new technologies, such as the fluorescent dyes indocyanine green (ICG) and near-infrared fluorescence (NIR), and pathologic ultrastaging, Indocyanine green fluorescence-imaging (ICG-FI) has emerged as a potential tool for increasing the accuracy of staging of patients with primary colorectal cancer (CRC) through the detection of sentinel lymph nodes (SLNs).&#x0D; Indocyanine green (ICG) is an inexpensive and safe non-specific fluorescent probe. SLN detection rate has increased and false-negative rate has decreased.Colorectal cancer is the third most common cancer in the Western hemisphere and the incidence increases with increasing age. Surgery is the only curative therapy for localized colorectal cancer and adjuvant chemotherapy is usually recommended for patients with lymph node metastases. Surgery, radiation therapy and chemotherapy are the key components of rectal cancer therapy.&#x0D; Local recurrence greatly affects the treatment efficiency and the survival outcomes for patients with rectal cancer. Lateral pelvic lymph node (LPLN) metastasis (LPNM) is an important factor for local recurrence. Accurate staging TNM of colorectal cancer is essential for evaluating the prognosis and developing an optimal treatment strategy. The presence of metastatic lateral pelvic lymph nodes has been shown to portend a worse prognosis for patients with low rectal cancer. SLN biopsy should be used in this patients for evaluating the prognosis and developing an optimal treatment strategy. Only with all of the above diagnostic tools can accurate diagnosis according to TNM and the choice of the right treatment strategy. The article analyzes and summarizes the scientific literature data on the methods for determining the sentinel lymph node. The sensitivity and specificity of the sentinel lymph node detection using ICG/NIR has been demonstrated. The analysis of various techniques for introducing indocyanine green, the rate of SLN identification was carried out.

Sentinel Lymph Node Biopsy in Early Breast Cancer Using the Indocyanine Green Fluorescence Technique: A Validation Study

INTRODUCTION: Introduction: Sentinel lymph node biopsy (SLNB) is now recognized as the standard of care for early breast cancer patients with negative axillary lymph nodes. Various approaches for Sentinel Lymph Node (SLN) identification using either the blue dye method or scintigraphy alone or their combination have been proposed. However, this method is costly and may not be applicable in certain developing countries. SLNB involving the use of indocyanine green (ICG) offers several advantages, and it is valid and safe when in direct comparison with the blue dye method and scintigraphy. Hence, we performed SLNB using this method in early breast cancer as the first center that involves the use of ICG in Malaysia. We performed validation study on this method with the aims to determine its sensitivity and safety profile. MATERIALS AND METHODS: This is a validation and non-randomised prospective observational study involving 20 patients underwent SLNB wherein ICG is used for localisation. The patients were recruited according to the recommendations stipulated in the Malaysia Clinical Practice Guideline. RESULT: The average number of SLNs removed per patient was 4.0 (range, 3–6) with sentinel lymph nodes detection rate at 98.75% (79/80). The false negative rate is at 5%. No adverse events were observed in all cases. CONCLUSION: The ICG fluorescence method is simple, reliable and safe. Moreover, it demonstrates a high SLN detection rate with a low false-negative rate, and it does not require a special instrument for radioisotope use.

Preoperative planar lymphoscintigraphy allows for sentinel lymph node detection in 51 dogs improving staging accuracy: Feasibility and pitfalls.

Sentinel lymph node (SLN) mapping is the current gold standard for the oncological staging of solid malignancies in humans. This prospective observational study describes the feasibility and the limits of preoperative lymphoscintigraphy for SLN detection in dogs with spontaneous malignancies and the improvements in staging accuracy. Client‐owned dogs with confirmed malignant neoplasia and absence of distant metastasis were prospectively enrolled. Lymphoscintigraphy was performed after the peritumoral injection of Technetium‐99m labeled nanocolloids. Regional dynamic and static images were acquired, with and without masking of the injection site with a lead shield. The dogs were then subjected to surgery for tumor excision and SLN extirpation. Intraoperative SLN detection was performed by combining methylene blue dye and a dedicated gamma probe. Overall, 51 dogs with a total of 60 solid malignant tumors were enrolled. Lymphoscintigraphy identified at least one SLN in 57 of 60 cases (95%). The SLN did not always correspond to the regional lymph node (35/57, 61.4%). The use of a lead shield, masking the injection site, markedly improved the SLN visibility. The median time of SLN appearance was 11.4 ± 9.3 min. No side effects were observed. Preoperative lymphoscintigraphy allows for SLN detection in dogs and can improve staging accuracy by either identifying the SLN in a different lymphosome than clinically expected or discriminating the draining node in uncertain cases. The combined use of preoperative and intraoperative techniques is recommended to increase the SLN detection rate.

Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer.

Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer.

Carbon nanoparticles combined with indocyanine green for sentinel lymph node detection in endometrial carcinoma

To evaluate the feasibility and clinical value of the combination of carbon nanoparticles (CNPs) and indocyanine green (ICG) for identifying sentinel lymph nodes (SLNs) in endometrial cancer. About 153 patients with endometrial cancer were recruited from July 2015 to May 2019. All patients underwent SLN biopsy according to the SLN algorithm for surgical staging with ICG and/or CNPs. The detection rate, factors associated with the detection rate, sensitivity, and negative predictive value (NPV) of SLNs were analyzed. The detection rates of SLNs with the combined method were the highest among the different methods. As calculated per hemipelvis, the sensitivity and NPV with ICG alone or with ICG plus CNPs were 100%. With CNP, tumor Grade 3 and laparoscopy were related to unsuccessful overall SLN mapping while tumor diameter greater than 2 cm and laparoscopy were statistically associated with failed bilateral mapping. With ICG, a higher body mass index was significantly associated with unsuccessful bilateral detection of SLN. SLN assessment in endometrial cancer is feasible and safe with high sensitivity and high NPV when ICG and CNPs are combined and in low-risk patients. It is a superior option to use CNPs in laparotomy for patients with endometrial cancer.

Magnetic nanoparticle technique versus radioisotope technique in detection of sentinel lymph node in early breast cancer: a systematic review and meta-analysis

Sentinel lymph node biopsy is the standard technique to stage the axilla in early breast cancer. The gold standard is the dual technique of radioisotope and blue dye injection. The drawbacks of dual technique include handling and disposal of radioactive material. Equally reliable, user and patient friendly, magnetic tracer super paramagnetic iron oxide, was compared with the radioisotope tracer in detection of Sentinel lymph node in a clinically node negative axilla in early breast cancer in this meta-analysis, with emphasis on the utility and safety of both techniques. PubMed, Medline were searched from April 2015 to October 2019. 1395 patients’ data was included from seven homogenous studies in this meta-analysis. A statistical analysis was performed using STATA 16.1 version for sentinel lymph node detection rate using standard technique, magnetic tracer technique and both techniques. Ratio of successes and failures of the outcomes was measured and analysed. A paired two sample ‘Z’ test was performed to compare between the standard technique and magnetic tracer techniques. The standardised mean difference of ratio of success rate between two techniques was; 1.013334 with a p value of 0.3136.The standardised mean difference of ratio of failure rate between two techniques was 1.016667, with a p value of 0.3132. Success and failure rate showed statistically no significant difference between the two techniques. This two-way analysis with paired two sample ‘Z’ test confirms that neither standard technique nor magnetic tracer techniques are superior or inferior to each other.

Repeat injection following sentinel node nonvisualization on lymphoscintigraphy images can decrease axillary dissection rate in breast cancer patients.

Sentinel node biopsy is considered the standard of care in early-stage breast cancer patients. In the current study, we evaluated the effect of radiotracer reinjection in the case of sentinel node nonvisualization on preoperative lymphoscintigraphy. Between March 2017 and March 2020, 1850 early-stage breast cancer patients were referred for sentinel node mapping. All patients received a single injected activity of Tc-99m Phytate intradermally in the periareolar area of the index lesion using an insulin syringe. Lymphoscintigraphy images of the patients were done 1-2 h postinjection. Between March 2017 and September 2017, sentinel node nonvisualization was reported to the surgeon, and for the rest of the study period, the patients received another injected activity of the radiotracer, and immediately, other lymphoscintigraphy images were taken (with the same parameters). A total of 255 patients entered our study. Fifty-five patients were in group I without any reinjection. The remainder of the patients were in group II. In 155 out of 200 patients of group II, a sentinel node could be visualized following reinjection of the radiotracer. The detection rate was 15 out of 45 and 15 out of 55 in group I and patients without sentinel node visualization even after reinjection, respectively. Axilla was involved in 5 out of 40 (12.5%) patients in group I with intraoperative sentinel node mapping failure. On the other hand, axilla was involved in 27 out of 30 (90%) group II patients with sentinel node nonvisualization. Reinjection of the tracer in cases of no sentinel node visualization in lymphoscintigraphy for breast cancer increases the detection rate of sentinel nodes, and therefore a high number of unnecessary axillary lymph node dissections can be avoided.

Combined use of ICG and technetium does not improve sentinel lymph node detection in endometrial cancer: Results of the COMBITEC study

ObjectiveThere is scarce evidence available about the benefit of combining technetium (99mTc) and indocyanine green (ICG) for sentinel lymph node (SLN) biopsy in endometrial cancer. The aim of this study was to compare the overall and bilateral pelvic detection rates of SLNs in two retrospective cohorts: ICG exclusive vs. combined ICG+99mTc. MethodsThe COMBITEC study (COMBined ICG and Technetium for SLN detection in Endometrial Cancer) consisted of a multicentre retrospective study (February 2015–June 2020) including patients diagnosed with endometrial atypical hyperplasia or early-stage endometrial carcinoma who underwent SLN biopsy by cervical injection of ICG with or without 99mTc in four different referral centers in Spain. ResultsA total of 180 patients were included, 51% (n = 92) in ICG group and 49% (n = 88) in ICG+99mTc group. Eighty-seven percent of the patients presented endometrioid histology, and over 99% of the procedures were performed by a minimally invasive approach. Both groups were comparable regarding their basal characteristics, except for a higher body mass index in ICG+99mTc group and a bigger proportion of robotic-assisted procedures in ICG group.Overall detection rate was 92.8% without significant differences between groups (ICG: 94.6% vs ICG+99mTc: 90.9%, p = .34). No significant differences were observed neither in bilateral pelvic nor aortic mapping rate. When 99mTc was used, surgical procedures were significantly longer. In 7.3% of mapped patients, at least one positive SLN was found (ICG: 10.3% vs ICG+99mTc: 3.9%, p = .109). Empty node packet rates and number of SLNs retrieved per patient were also similar between cohorts. ConclusionCombining preoperative 99mTc to intraoperative ICG did not improve SLN detection in endometrial cancer, but resulted in longer procedures.

Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer

ObjectivesTo evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging. MethodsWe retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG. ResultsIn total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively. ConclusionsOur results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.

Exploratory Study of the Clinical Value of Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green in Vulvar Cancer Patients.

BackgroundThis study aimed to evaluate the clinical value of indocyanine green sentinel lymph node (SLN) mapping in patients with vulvar cancer. The conventional procedure of SLN mapping in vulvar cancer includes peritumoral injection of technetium-99m nanocolloid before surgery and intraoperative injection of a blue dye. However, these techniques harbor some limitations. Near-infrared fluorescence imaging with indocyanine green has gained popularity in SLN mapping in different types of cancer.MethodsWe analyzed retrospectively vulvar cancer patients at our institution between 2013 and 2020 undergoing indocyanine green SLN mapping by applying video telescope operating microscope system technology.Results64 groins of 34 patients were analyzed. In 53 groins we used technetium-99m nanocolloid, in four patent blue, and in five both techniques, additionally to indocyanine green for SLN detection. In total, 120 SLNs were identified and removed. The SLN detection rate of indocyanine green was comparable to technetium-99m nanocolloid (p=.143) and higher than patent blue (p=.003). The best results were achieved using a combination of ICG and technetium-99m nanocolloid (detection rate of 96.9%). SLN detection rates of indocyanine green were significantly higher in patients with positive lymph nodes (p=.035) and lymphatic space invasion (p=.004) compared to technetium-99m nanocolloid.ConclusionIndocyanine green SLN mapping in vulvar cancer is feasible and safe, with reasonable detection rates. Due to its easy application and few side effects, it offers a sound alternative to the conventional SLN mapping techniques in vulvar cancer. In patients with lymph node metastasis, indocyanine green even outperformed technetium-99m nanocolloid in terms of detection rate.

Clinical study of combined application of indocyanine green and methylene blue for sentinel lymph node biopsy in breast cancer.

Objective:This study aims to investigate the feasibility of combined application of indocyanine green (ICG) and methylene blue (MB) for sentinel lymph node biopsy (SLNB) in patients with early breast cancer.Methods:A total of 415 patients who underwent SLNB and axillary lymph node dissection were enrolled. Sentinel lymph node (SLN) was assessed in 197 patients with ICG and MB combination method, while, the other 218 patients were detected by MB method alone. During surgery, all SLNs were harvested for pathological examination. Then the detection rate and false negative rate of SLNs were comparatively analyzed between the 2 groups.Results:In the combined ICG and MB group, the detection rate of SLNs was 96.9%, significantly higher than that of MB group, which was 89.7% (P < .05). Similarly, in combined group, the average number of SLNs per patient was 3.0, much higher than that of MB group, which was 2.1 (P < .05). There was no statistically significant difference in false negative rate between combined group and MB alone group, which was 7.3% and 10.5%, respectively (P = .791).Conclusion:The combined application of ICG and MB for SLNB is much more effective than MB alone in detecting SLNs.

Avoiding Full Lymphadenectomies in Intermediate- and High-Risk Endometrial Cancer by Sentinel Lymph Node Biopsy Implementation.

ObjectiveTo evaluate the role of sentinel lymph node biopsy (SLNB) to avoid staging lymphadenectomies by detecting nodal metastasis in intermediate- and high-risk endometrial cancer (EC).MethodsA single institutional retrospective study was performed including all patients with intermediate- and high-risk EC who underwent surgical nodal staging between January 2012 and December 2019. Patients with disseminated disease detected on imaging techniques or at the time of surgery were excluded. Patients were evaluable if they underwent nodal staging with SLNB and pelvic (PLD) and paraaortic (PALD) lymph node dissection. We analyzed the accuracy of the sentinel lymph node technique. Only patients with at least one sentinel lymph node (SLN) detected were included in the sensitivity and negative predictive value (NPV) analyses. The tracers used were technetium 99m, blue dye, and indocyanine green.ResultsEighty-eight patients presented intermediate- and high-risk EC (51 patients and 37 patients respectively) and underwent SLNB with consecutive PLD and PALD. The median (range) number of sentinel nodes retrieved was 2.9 (0–11). The global detection rate of SLN was 96.6% with a bilateral detection of 80.7% when considering all tracers used. However, when combination of indocyanine green and technetium was used the bilateral detection rate was 90.3%. Nodal metastases were detected in 17 (19.3%) cases, 8 (47%) of them corresponded to low volume metastasis (LVM), 7 (87.5%) of them diagnosed at ultrastaging pathologic exam. Finally, we obtained a sensitivity of 90%, a NPV of 97.5%, and a false negative rate (FNR) of 10% in the intermediate-risk EC compared to sensitivity of 85.7%, NPV of 96.6%, and FNR of 14.3% in the high-risk EC group. The only patient with isolated paraaortic nodal metastasis was found at the high-risk group, 1.1%.ConclusionsAccording to our results, full lymphadenectomy could be avoided by performing SLNB in patients with intermediate-risk EC because the only false negative case detected was at the beginning of ICG learning curve. For high-risk EC patients we did not find enough evidence to support the systematic avoidance of staging full lymph node dissection. Nevertheless, SLNB should be performed in all cases of EC as it improves LVM diagnosis substantially.

Comparison of SPECT-CT with intraoperative mapping in cervical and uterine malignancies

IntroductionThe objective was to evaluate whether hybrid imaging combining single photon emission tomography with computed tomography (SPECT/CT) provides additional clinical value for dectection of sentinel lymph nodes (SLNs) compared with...