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Optimizing Strategies for Sentinel Lymph Node Mapping in Early-Stage Cervical and Endometrial Cancer: Comparison of Real-Time Fluorescence With Indocyanine Green and Methylene Blue
  1. Alessandro Buda, MD*,,
  2. Giampaolo Di Martino, MD,
  3. Francesca Vecchione, MD*,
  4. Beatrice Bussi, MD,
  5. Tiziana Dell’Anna, MD*,
  6. Sharon Palazzi, MD,
  7. Maria Grazia Cantù, MD*,
  8. Martina Delle Marchette, MD and
  9. Rodolfo Milani
  1. *Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital; and
  2. University of Milano-Bicocca, Monza, Italy.
  1. Address correspondence and reprint requests to Alessandro Buda, MD, Gynecologic Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. E-mail:


Objective This retrospective study aimed to compare the sentinel lymph node (SLN) mapping results of methylene blue (MB) and indocyanine green (ICG) in women with early-stage endometrial or cervical cancer.

Methods From August 2011 to March 2015, all consecutive patients with stage I endometrial or cervical cancer who underwent SLN mapping with intracervical injection of MB or ICG using a 22-gauge spinal needle were included in the study. Radical or simple hysterectomy with bilateral pelvic and/or aortic lymphadenectomy was performed after SLN mapping.

Results Overall, 81 women (64 women with endometrial cancer and 17 women with cervical cancer) underwent surgery, including SLN mapping. Sixty-five patients (80%) underwent minimally invasive surgery. The overall detection rate was 84% (34 of 38) and 100% (43 of 43) for MB and ICG, respectively (P = 0.041). Bilateral SLN detection was higher in the ICG group than in the MB group (88% vs 50; P = 0.002). Eleven patients (13.5%) were found to have positive nodes with at least 1 positive SLN. The sensitivity and negative predictive value of SLN were 100%.

Conclusions Real-time florescence mapping with ICG shows better overall detection rate and bilateral mapping than MB alone. In our pilot study, the differences are statistically significant. The higher number of bilateral mapping of ICG may increase the quality of life and recovery of women by reducing the need for complete lymphadenectomy.

  • Sentinel lymph node mapping
  • Methylene blue
  • Indocyanine green
  • Endometrial cancer
  • Cervical cancer

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  • The authors declare no conflicts of interest.