Laparoscopic Sentinel Node Biopsy Research Articles

Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) retroperitoneal sentinel lymph node BIOPSY compared with conventional laparoscopy in patients with endometrial cancer

IntroductionTo explore the possibility of treatment with VNOTES sentinel lymph node dissection concept in patients with endometrial cancer. MethodsPatients who underwent VNOTES sentinel lymph node biopsy with the Comba modification were compared to patients who underwent conventional laparoscopic sentinel lymph node biopsy performed by the same surgical team. A total of 38 patients who underwent sentinel lymph node biopsy + total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (BSO) were compared with 19 patients who underwent VNOTES retroperitoneal sentinel lymph node biopsy + hysterectomy and BSO. Surgical steps were described. ResultsThe average operation time, perioperative blood loss, the number of sentinel lymph nodes, presence of complications, and preoperative-postoperative hemoglobin-hematocrit differences, tumor stages, grades, largest tumor diameter, depths of invasion, and histological subtypes were similar in both the VNOTES and conventional laparoscopy groups. The postoperative pain scores were lower and the hospital stay was shorter in the VNOTES group than in the conventional laparoscopy group. No disease recurrence had been detected in either group at the time of writing. ConclusionCompared to conventional laparoscopy, sentinel lymph node biopsy with the VNOTES technique provides similar surgical results and is more advantageous in terms of postoperative pain and hospital length of stay.

Clinical and Surgical Evaluation of Sentinel Node Biopsy in Patients with Early-Stage Endometrial Cancer and Atypical Hyperplasia.

The medical and surgical treatment of endometrial cancer (EC) is evolving toward a more patient-centered and personalized approach. The role of laparoscopic sentinel node biopsy (SNB) for early-stage EC is unclear, and very few data are available for atypical endometrial hyperplasia (AEH). The present study investigated the effectiveness of SNB combined with laparoscopic hysterectomy in patients with early-stage EC and AEH. This was a retrospective, single-center cohort study for the period from January 2018 to December 2023. A total of 102 patients with atypical hyperplasia (n=20) and early-stage EC (n=82) findings on diagnostic curettage underwent pelvic sentinel node biopsy during the final operation. Eleven patients (55%) who had initially been diagnosed with AEH were found to have EC in the final pathology report. No lymph node metastases were detected in patients who had initially been diagnosed with AEH; a 3.6% rate of positive SNBs was found in patients with EC. Changes in tumor grade occurred in 31.3% of the patients and changes in FIGO stage in 33%. Bilateral sentinel node (SN) mapping was successful in 94.1% of the patients. The postoperative outcomes were comparable to those of routine clinical practice without SNB. SNB can be safely offered to patients who have precursor lesions and early-stage EC without notably extending surgical times or increasing postoperative morbidity. This approach can be considered and is safe for patients diagnosed with AEH, but it appears to have a rather small impact on these patients.

Oncologic Outcome of Robotic-Assisted and Laparoscopic Sentinel Node Biopsy in Endometrial Cancer.

Recently, sentinel lymph node biopsy (SLNB) has been introduced in the surgical staging of endometrial cancer as an alternative to systematic lymph node dissection (LND). However, the survival impact of SLNB is not yet well characterised. We performed a retrospective study of 419 patients with endometrial cancer treated with SLNB alone or with pelvic and para-aortic LND. For SLNB mapping, indocyanine green was used. Median follow-up was 66 months. After exclusions, 337 patients were eligible for analysis. Of them, 150 underwent SLNB and 187 LND. During the follow-up time, 27 (24.7%) of the 150 who underwent SLNB and 54 (28.9%) of the 187 who underwent LND were diagnosed with recurrent disease (p = 0.459). The estimated 5-year disease-free survival (DFS) rate was 76.7% and 72.2% for patients in the SLNB and LND group, respectively (p = 0.419). The 5-year overall survival (OS) rates were 80.7% and 77.0% in the SLNB and LND group, respectively (p = 0.895). Survival rates were similar in both groups independent of lymph node status. Multivariable analysis confirmed that the staging approach was not associated with oncological outcome. For patients without lymph node metastases, patient outcome was worsened by advanced tumour stage and non-endometrioid tumour histology. In the group of patients with confirmed lymph node metastases, advanced tumour stage and inadequate adjuvant treatment significantly reduced DFS and OS. Our data suggested that SLNB did not compromise the oncological outcome of patients with endometrial cancer compared to LND.

Laparoscopic sentinel lymph node mapping with indocyanine green in endometrial cancer: surgeon’s learning curve (cumulative sum analysis)

ObjectivesTo evaluate surgeons’ learning curves for laparoscopic sentinel lymph node biopsy in endometrial cancer.MethodsA prospective observational study was performed at the Oncogynecology Center, Lithuanian University of Health Sciences Hospital, from...

Laparoscopic sentinel lymph node dissection followed by open radical hysterectomy for early stage cervical cancer: A pilot study.

To propose a treatment algorithm, after the LACC trial, of laparoscopic sentinel lymph node biopsy with frozen section, followed by immediate open radical hysterectomy in node-negative cases, for early stage cervical cancer. We retrospectively collected all cases of cervical cancer that were surgically treated between 2019-2020. In all cases, surgery began with laparoscopic sentinel lymph node biopsy±ovarian transposition. Node-negative cases continued with open radical hysterectomy. In node-positive cases, surgery was discontinued, sparing the patient a laparotomy incision. Nine patients with cervical cancer were referred for surgery. Laparoscopic bilateral lymph node identification was achieved in all. In two cases, sentinel lymph nodes were positive for metastatic cancer and surgery was discontinued. For the other seven, node-negative patients, open radical hysterectomy was completed. Four patients had laparoscopic ovarian transposition. There were no cases where nodes were negative on frozen section but positive on final pathology. Laparoscopic sentinel lymph node biopsy before open radical hysterectomy may spare a considerable number of laparotomies on the one hand and bi-modal treatment with surgery and radiation on the other, for node-positive patients. The oncological safety of this approach is yet to be determined.

Vaginal fertility-sparing surgery and laparoscopic sentinel lymph node detection in early cervical cancer. Retrospective study with 15 years of follow-up

ObjectiveThe aim of this study was to evaluate the oncological outcomes of vaginal fertility-sparing surgery plus laparoscopic sentinel lymph node biopsy in patients with early cervical cancer over a 15-years period. Patients and methodsFrom March 2005 to April 2018, 38 patients diagnosed with early stage cervical cancer underwent vaginal fertility-sparing surgery at the Hospital Clínic, Barcelona, Spain. Patients with FIGO stage IA1 with lymphovascular space invasion and stage IA2 underwent simple trachelectomy and patients with stage IB1 underwent radical vaginal trachelectomy. All cases underwent laparoscopic sentinel lymph node biopsy. In the first 19 cases, laparoscopic bilateral pelvic lymphadenectomy was completed immediately after sentinel lymph node biopsy. Clinical and oncological follow-up data were collected. ResultsThe median age at diagnosis was 33.5 years (range 22–44). Simple trachelectomy was performed in seven cases (18.4%) and vaginal radical trachelectomy in 31 (81.6%). Nineteen patients were exclusively treated with laparoscopic sentinel lymph node biopsy and 19 with sentinel lymph node biopsy plus laparoscopic bilateral pelvic lymphadenectomy. There were no significant differences between the two lymph node assessment groups regarding histology and tumour size. The median follow-up was 73 months (range 1–160 months). There were 4 recurrences (3 patients with IB1 and 1 with IA2). Two occurred in the sentinel lymph node biopsy group and 2 in the sentinel lymph node biopsy plus laparoscopic bilateral pelvic lymphadenectomy group. All the recurrences were diagnosed in patients with adenocarcinoma and in 3 patients without lymphovascular space invasion. ConclusionVaginal fertility-sparing surgery combined with laparoscopic sentinel lymph node biopsy seems to be a safe oncological procedure in selected patients with early stage cervical cancer. Further studies are needed to clarify the role of sentinel lymph node biopsy in fertility- sparing surgery in cervical cancer. Adenocarcinoma histology seems to be an important risk factor for recurrence.

Feasibility and validity of laparoscopic sentinel lymph node biopsy for early stage cervical cancer

Feasibility and validity of laparoscopic sentinel lymph node biopsy for early stage cervical cancer

This video shows a fluoroscopic laparoscopic sentinel lymph node biopsy and an extensive total hysterectomy without a uterine manipulator

This video shows a fluoroscopic laparoscopic sentinel lymph node biopsy and an extensive total hysterectomy without a uterine manipulator

Clinical Study of Nano-carbon Combined With 3D Laparoscopic Sentinel Lymph Node Biopsy for Early Cervical Cancer

Study Objective To investigate the feasibility and clinical application of early cervical application of nano-carbon tracer imaging of sentinel lymph node (the SLN) under laparoscopic 3D. Design 50 patients diagnosed with early cervical cancer patients, cervical injection nanometers from preoperative Carbon-suspended injection.3D laparoscopic direct recognition of black-stained lymph nodes as SLN and excision, followed by laparoscopic pelvic lymphadenectomy + extensive hysterectomy (+ abdominal para-aortic lymph node sampling). Setting Xinxiang City Central Hospital Gynecologic Oncology, China. Patients or Participants 50 patients diagnosed with early cervical cancer patients were enrolled. Interventions 3D laparoscopic direct recognition of black-stained lymph nodes as SLN and excision, followed by laparoscopic pelvic lymphadenectomy + extensive hysterectomy (+ abdominal para-aortic lymph node sampling). Measurements and Main Results A total of 1476 lymph nodes were removed from 50 patients. SLN was successfully detected. The detection rate of SLN was 100% (50/50). A total of 445 SLNs were detected, accounting for 43.20% (445/1030) of the total number of lymph nodes. SLNB detection sensitivity 100% (50/50), specificity 100.00% (50/50), SLN prediction of pelvic lymph node status and postoperative pathological examination coincidence rate of 100% (50/50), negative predictive value of 100.00% (50/50). Conclusion The metastatic state of SLN in early cervical cancer is consistent with the true metastatic state of pelvic lymph nodes, which has a more accurate pathological representative significance. Laparoscopic detection of SLN in early cervical cancer using nano-carbon tracer is a comparative method. Safe and feasible, SLNB has to replace traditional cervical cancer pelvic lymphadenectomy, narrowing the scope of surgery and reducing trauma.

Feasibility of hand-assisted laparoscopic sentinel node biopsy in open endometrial cancer surgery

Background: The aim of this preliminary retrospective study was to assess the feasibility and accuracy of Indocyanine Green (ICG) sentinel node (SLN) sampling using a laparoscopic camera during open endometrial cancer surgery.Material and methods: Retrospective study. Fourteen women with endometrial cancer, not fit for a complete laparoscopic staging, underwent SLN mapping using the IMAGE1 camera during open surgery.Results: The median age of patients was 67 (range 33–86) years. Median BMI was 31 (range 23–58). Mean operative time 157.5 minutes and hospital stay three days. The overall detection rate of SLN mapping was 93%. Bilateral detection was 86%. No post-operative short or long-term complications were observed.Conclusions: Real-time NIR technology supported by the IMAGE1 S is a reliable system and represents a promising method for SLN mapping in selected cases with EC and severe surgical risks, during 48 traditional open approaches. The use of laparoscopy ICG in open surgery seems to be a feasible and useful tool for the detection of SLN in endometrial cancer patients with intraoperative and/or postoperative high morbidity risk. It represents a valid alternative to robotic surgery, particularly in countries and centers where the robotic platform or SPY system for open surgery are not available.

Separation of excitation and detection coils for in vivo detection of superparamagnetic iron oxide nanoparticles

Abstract A novel probe for laparoscopic in vivo detection of superparamagnetic iron oxide nanoparticles (SPIONs) has been developed. The main application for in vivo detection of SPIONs our research group aims at is sentinel node biopsy. This is a method to determine if a tumor has spread through the body, which helps to improve cancer patient care. The method we use to selectively detect SPIONs is Differential Magnetometry (DiffMag). DiffMag makes use of small magnetic field strengths in the mT range. For DiffMag, a handheld probe is used that contains excitation and detection coils. However, depth sensitivity of a handheld probe is restricted by the diameter of the coils. Therefore, excitation and detection coils are separated in our novel probe. As a result, excitation coils can be made large and placed underneath a patient to generate a sufficiently large volume for the excitation field. Detection coils are made small enough to be used in laparoscopic surgery. The main challenge of this setup is movement of detection coils with respect to excitation coils. Consequently, the detector signal is obscured by the excitation field, making it impossible to measure the tiny magnetic signature from SPIONs. To measure SPIONs, active compensation is used, which is a way to cancel the excitation field seen by the detection coils. SPIONs were measured in various amounts and at various distances from the excitation coils. Furthermore, SPIONs were measured in proximity to a surgical steel retractor, and 3 L water. It is shown that small amounts of SPIONs (down to 25 μg Fe) can be measured, and SPIONs can be measured up to 20 cm from the top of the excitation coil. Also, surgical steel, and diamagnetism of water – and thus of tissue – have minor influence on DiffMag measurements. In conclusion, these results make this novel probe geometry combined with DiffMag promising for laparoscopic sentinel node biopsy.

Laparoscopic sentinel node navigation surgery for early gastric cancer

Currently, the most accurate method for identifying lymph node metastasis is intraoperative diagnosis by sentinel node (SN) biopsy. Based on the SNNS study-a recent large-scale, nationwide, multicenter prospective study-the SN concept seems to be scientifically valid in patients with early gastric cancer. SN biopsy is a multistep technique consisted of six essential elements: indication, the selection of a tracer, a proper tracer injection method, the objective detection of SNs, a reliable biopsy technique, and the precise detection of nodal metastasis. For SN biopsy of gastric cancer, these elements have been validated as follows: the indication should be limited to clinical T1 less than 4 cm in diameter; combination mapping with radioactive colloid and blue dye is used as the standard; and endoscopic submucosal injection is the standard tracer injection. Detection of SNs and a reliable biopsy technique are enabled by adaptation of lymphatic basin dissection, a proper biopsy technique for gastric cancer. Lymphatic basin dissection is a selective lymphadenectomy procedure for dissecting basins en bloc, collecting lymph nodes and lymphatic vessels stained with dye. Lymphatic basin dissection is superior to the ordinary pick-up method, not only for minimizing the rate of missed SNs, but also in terms of oncological safety as it complements an intraoperative frozen section diagnosis by serving as a backup dissection. Moreover, indocyanine green (ICG) fluorescence mapping has been developed in recent years. ICG fluorescence mapping is superior because of its high sensitivity and signal stability. Moreover, it is feasible for both open and laparoscopic gastrectomy in treating early gastric cancer. SN biopsy has brought dramatic changes to laparoscopic surgery for early gastric cancer. With laparoscopic SN biopsy using ICG fluorescence navigation, laparoscopic surgery for early gastric cancer has changed from the uniform standard gastrectomy with D1+ into a tailor-made function-preserving surgical procedure, such as local resection with lymphatic basin dissection.

Perspective of new techniques overcoming laparoscopic sentinel node biopsy for early gastric cancer.

The modern standard curative procedure for early gastric cancers falling outside the indication parameters for endoscopic resection is laparoscope-assisted gastrectomy with lymph node dissection. Patients undergoing standard gastrectomy with lymph node dissection experience postgastrectomy symptoms. These symptoms often pose life-long problems for patients. Thus, lymph node dissection should be avoided to preserve the stomach, alleviate the aforementioned symptoms, and improve postoperative quality of life. At present, sentinel lymph node (SN) biopsy is the most reliable method for identification of node-negative cases.

Molecular Diagnosis for Nodal Metastasis in Endoscopically Managed Cervical Cancer: The Accuracy of the APTIMA Test to Detect High-risk Human Papillomavirus Messenger RNA in Sentinel Lymph Nodes

Study ObjectiveTo evaluate the feasibility and accuracy of a commercially available test to detect E6/E7 mRNA of 14 subtypes of high-risk HPVs (APTIMA; Hologic, Bedford, MA) in the sentinel lymph nodes of CC patients laparoscopically operated. DesignProspective pilot study. SettingThe study was conducted in the Department of Advanced Operative and Oncologic Gynecology, Asklepios Hospital, Hamburg, Germany. Patients54 women with HPV-positive CC submitted to laparoscopic sentinel node biopsy alone or sentinel node biopsy followed by systematic pelvic and/or para-aortic endoscopic lymphadenectomy. InterventionsAll removed sentinel lymph nodes (SLNs) underwent sample collection by cytobrush for the APTIMA assay before frozen section. MeasurementsResults obtained with the HPV mRNA test were compared with the definitive histopathological analysis of the SLNs and additional lymph nodes removed. ResultsA total of 125 SLNs (119 pelvic and 6 paraaortic) were excised with a mean number of 2.3 SLNs per patient. Final histopathologic analysis confirmed nodal metastases in 10 SLNs from 10 different patients (18%). All the histologically confirmed metastatic lymph nodes were also HPV E6/E7 mRNA positive, resulting in a sensitivity of 100%. Four histologically free sentinel nodes were positive for HPV E6/E7 mRNA, resulting in a specificity of 96.4%. ConclusionThe HPV E6/E7 mRNA assay in the SLNs of patients with CC is feasible and highly accurate. The detection of HPV mRNA in 4 women with negative SLNs might denote a shift from microscopic identification of metastasis to the molecular level. The prognostic value of this findings awaits further verification.

Laparoscopic Indocyanine Green Sentinel Lymph Node Mapping in Pregnant Cervical Cancer Patients

We present cases of 2 pregnant patients with early-stage cervical cancer who have undergone indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by laparoscopic SLN biopsy, pelvic lymphadenectomy, and cervical conization. Eight milliliters of ICG were injected in the 4 quadrants of the cervix after having obtained an adequate pneumoperitoneum and having inspected the abdominal cavity. SLNs were identified in both hemipelvises in both patients. In the final pathologic analysis, both SLNs and non-SLNs were negative for metastatic disease. No adverse events from ICG injection were recorded. ICG SLN mapping seems to be feasible in pregnant cervical cancer patients.

Laparoscopic Sentinel Node Navigation Surgery for Gastric Cancer

Short-term surgical results of gastric cancer improve with use of a laparoscopic approach compared to those after conventional laparotomy, particularly in patients with early gastric cancer (EGC). However, due to gastric resection and lymph node dissection, poor long-term quality of life (QOL) after gastric cancer surgery is equivalent between the approaches. Thus, gastric resection and lymph node dissection should be minimized to avoid injury to innervating nerves and the sphincter, to maintain gastric function, preserve gastric volume, and improve long-term QOL. Such a procedure should not impair the oncological outcome by removing the primary tumor and metastasis to lymph nodes. After analysis of the many single center feasibility studies, sentinel node biopsy (SNB) is useful for this purpose but sensitivity varies and is unsatisfactory. A large multicenter Japanese feasibility study showed promising results after clinical application of SNB in patients with EGC. Based on those results, a multicenter prospective randomized phase III trial of laparoscopic SNB conducted by the Korean surgical study group, the SENORITA (SEntinel Node ORIented Tailored Approach), is now ongoing. Prior to this phase III trial, a quality control study of participating institutions was completed in an effort to standardize and overcome the SNB learning curve. Laparoscopic SNB with gastric volume and function-preserving surgery to improve the long-term QOL without impairing the oncological outcome may be a surgical option after this trial in the subgroup of patients with EGC.

876 Multispectral fluorescence imaging during robot-assisted laparoscopic sentinel node biopsy, a first step towards a real-time fluorescence-based anatomical roadmap

876 Multispectral fluorescence imaging during robot-assisted laparoscopic sentinel node biopsy, a first step towards a real-time fluorescence-based anatomical roadmap

Sentinel Node Navigation Surgery in Patients with Early Gastric Cancer

Clinical application of sentinel node (SN) mapping in patients with early gastric cancer has been a controversial issue for years. However, a recent meta-analysis and a prospective multicenter trial of SN mapping for early gastric cancer have shown acceptable SN detection rates and accuracy of determination of lymph node status. A dual-tracer method that utilizes radioactive colloids and blue dyes is currently considered the most reliable method for the stable detection of SNs in patients with early gastric cancer. However, new technologies such as indocyanine green infrared or fluorescence imaging might revolutionize the SN mapping procedures in gastric cancer. For early-stage gastric cancer such as cT1N0, for which a better prognosis can be potentially achieved through conventional surgical approaches, the establishment of individualized, minimally invasive treatments that may retain the patients' quality of life should be the next surgical challenge. Although there are many unresolved technical issues, laparoscopic SN biopsy with laparoscopic minimized gastrectomy or endoscopic mucosal resection/endoscopic submucosal dissection could be a promising strategy to achieve this goal.

New Sentinel Node Mapping Technologies for Early Gastric Cancer

The sentinel node (SN) concept has revolutionized the surgical staging of both melanoma and breast cancer over the past two decades. The application of this concept can yield benefits for patients by preventing various complications related to unnecessary prophylactic regional lymph node dissection in patients with cancer-negative SNs. Clinical application of SN mapping in patients with early gastric cancer has been a controversial issue for years. However, a recent meta-analysis and a prospective multicenter trial of SN mapping for early gastric cancer have shown acceptable SN detection rates and accuracy of determination of lymph node status. For early stage gastric cancer such as cT1N0M0, for which a better prognosis can be achieved through conventional surgical approaches, the establishment of individualized, minimally invasive treatments that may retain the patients' quality of life should be the next surgical challenge. Although there are many unresolved technical issues, laparoscopic SN biopsy with laparoscopic minimized gastrectomy or endoscopic mucosal resection/endoscopic submucosal dissection has the potential to achieve this goal.

Lymphatic mapping and laparoscopic sentinel node biopsy in early cervical cancer

Lymphatic mapping and laparoscopic sentinel node biopsy in early cervical cancer