Introduction/Background Sentinel lymph node (SLN) biopsy has been recently widely investigated in endometrial (EC) and cervical cancer (CC). Near-infrared (NIR) fluorescence imaging is rapidly gaining popularity despite being a relatively new technique associated with lack of uniformity in the application of the method used across centers. The aim of presented systematic review is to gather evidence regarding different technical aspects and their impact on the effectiveness of indocyanine green (ICG) use during SLN mapping.
Methodology A computer literature search using Medline was conducted for studies in EC and CC patients published in between January 2010 and May 2019. The initial search came up with 207 articles, of which 91 articles used ICG as a tracer.
Results 7446 patients were included in the final analysis, ranging from 1 to 472 patients per study. The main surgical approach was laparoscopy, followed by robotic surgery, laparotomy, hysteroscopy and natural orifice transluminal endoscopic surgery. The overall SLN detection rate using ICG ranged from 64% to 100% for cervical, from 83% to 100% for fundal and from 33% to 100% for hysteroscopic injections. Sensitivity and negative predictive value varied from 77,8% to 100% and 83% to 100%, respectively. The most common site of injection was the cervix injected submucosally and intrastromally in two quadrants. There is a large variation in the size of the needle, dilution solvent, concentration, dosage and volume of ICG injected as well as the time when the dye is injected and the period between injection and beginning of the dissection.
Conclusion ICG shows a high overall detection rate as well as sensitivity and specificity in SLN mapping in patients with EC and CC. The differences in results obtained in particular studies suggest that the details of injection procedure might influence the success rate in SLN detection.
Disclosure Nothing to disclose.
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