Introduction/Background Several techniques for sentinel lymph node biopsy (SLNB) in early-stage endometrial cancer have been previously described. However, little or no evidence is available regarding combined indocyanine green plus 99mTc-albumin nanocolloid (99mTc-NC+ICG). Combining 99mTc-NC+ICG may decrease the incidence of ‘empty lymph node packets’ and restrict ICG high diffusion and background signal, diminishing total SLNs per patient without compromising its accuracy.Our aim was to compare two different approaches to SLNB in early-stage endometrial cancer: combining methylene blue plus 99mTc-NC (99mTc-NC+MB) versus 99mTc-NC+ICG.
Methodology Consecutive patients with preoperative diagnosis of early-stage endometrial carcinoma in a single centre were offered to be included in our trial from February 2017 until March 2019. Patients were assigned to 99mTc-NC+MB or 99mTc-NC+ICG group depending on availability of special ICG-detector cameras.
Results A total of 71 patients were included for analysis, 67.6% (n=48) in 99mTc-NC+MB group and 32.4% (n=23) in 99mTc-NC+ICG group. Most patients presented early stage, grade 2, low risk endometrioid carcinoma. A minimally invasive approach was largely preferred (95.8%). Both groups were comparable regarding demographic and clinical variables, except for a bigger proportion of patients undergoing robotic surgery in the 99mTc-NC+ICG group (78.3% vs 35.4%, p=0.002).
Global detection rate (DR) was 94.4% (CI: 86.2–98.4), and was not statistically different among groups (99mTc-NC+MB: 93.8% vs 99mTc-NC+ICG: 95.7%). A better optimal (bilateral) mapping rate was observed among 99mTc-NC+ICG patients (69.5% vs 41.7%, p=0.028), with a statistically significant increase in the median of SLN analyzed per patient (3 vs 2, p=0.040).
A total of 5 (7.5%) patients had positive lymph nodes in definitive lymphadenectomy histology, all of whom had positive SLNs. Then, no false-negative SLN were observed in this cohort, achieving a sensitivity rate of 100%.
Conclusion 99mTc-NC+ICG is a feasible, oncologically safe technique for SLNB in early-stage endometrial cancer patients, appearing to be superior in terms of bilateral mapping to 99mTc-NC+MB.
Disclosure Nothing to disclose.
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