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A Comparison of the Detection of Sentinel Lymph Nodes Using Indocyanine Green and Near-Infrared Fluorescence Imaging Versus Blue Dye During Robotic Surgery in Uterine Cancer
  1. Ane Gerda Eriksson, MD*,
  2. Anna Beavis, MD*,,
  3. Robert A. Soslow, MD,§,
  4. Qin Zhou, MS,
  5. Nadeem R. Abu-Rustum, MD*,,
  6. Ginger J. Gardner, MD*,,
  7. Oliver Zivanovic, MD*,,
  8. Kara Long Roche, MD*,,
  9. Yukio Sonoda, MD*,,
  10. Mario M. Leitao, MD*, and
  11. Elizabeth L. Jewell, MD*,
  1. * Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY;
  2. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD;
  3. Department of Pathology, Memorial Sloan Kettering Cancer Center;
  4. § Department of Pathology and Laboratory Medicine, Weill Cornell Medical College;
  5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center; and
  6. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY.
  1. Address correspondence and reprint requests to Elizabeth L. Jewell, MD, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail: jewelle{at}mskcc.org.

Abstract

Objectives The objective of this study was to assess and compare the sentinel lymph node (SLN) detection rate with indocyanine green (ICG) and near-infrared fluorescence imaging versus blue dye using the robotic platform in patients with uterine cancer.

Methods We identified all patients with uterine cancer undergoing SLN mapping using ICG or blue dye on the robotic platform from January 2011 to December 2013. Our institutional SLN algorithm and pathologic processing protocol were adhered to uniformly. We compared detection rates of SLNs stratified by dye used. Appropriate statistical tests were used.

Results A total of 472 patients were identified. ICG was used in 312 patients (66%) and blue dye in 160 patients (34%). Successful mapping was achieved in 425 (90%) of 472 patients. Mapping was bilateral in 352 patients (75%) and unilateral in 73 patients (15%); 47 patients (10%) did not map. Successful mapping was achieved in 295 (95%) of 312 patients using ICG compared with 130 (81%) of 160 patients using blue dye (P < 0.001). Mapping was bilateral in 266 (85%) of 312 patients in the ICG group compared with 86 (54%) of 160 in the blue dye group (P < 0.001). Additional lymph node dissection beyond removal of the SLNs was performed in 122 patients (39%) mapped with ICG compared with 98 patients (61%) mapped with blue dye (P < 0.001).

Conclusions The SLN detection rate was superior when mapping with ICG rather than blue dye. Bilateral mapping was significantly improved, resulting in a lower rate of additional lymphadenectomy.

  • Uterine cancer
  • Sentinel lymph nodes
  • Indocyanine green
  • Near-infrared fluorescence imaging
  • Robotic surgery

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Footnotes

  • The authors declare no conflicts of interest.

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