Background Sentinel lymph node biopsy (SLN) is a promising investigational surgical technique for cervical cancer.
Aim To explore feasibility of SLN biopsy with ICG and patent blue dye (PTB) in cervical cancer.
Methods All patients who underwent planned laparoscopic or open sentinel lymph node biopsy with histologically confirmed cervical cancer 2017–2019 were included. Pre-operative stage was determined radiologically. Patients were excluded from the study if; there were suspected lymph node metastases on pre-operative imaging; any contra-indications to formal staging surgery; allergy to dye or evidence of metastatic disease (non-nodal).
Results 47 women had planned SNL: 18 with ICG alone, 20 with both ICG and PTB and 9 with PTB alone. Mean age at sample was 42. Surgery laparoscopic in 29 (61.7%) and by laparotomy in 18 (38.2%). One woman with planned SLN had an intraoperative finding of bulky lymph nodes and full pelvic lymphadenectomy (PLND) was performed. This patient was excluded from subsequent analysis. In other cases where no SLN was detected, PLND was performed, except in one case (habitus prevented this).
No patients had significant morbidity related to the procedure in long-term follow-up. The overall bilateral detection rate was 35/46 (76.1%) and the side-specific rate was 81/92 (88.0%). The bilateral detection rate for ICG (with or without PTB) was 29/37 (78.3%) and the side-specific detection rate was 65/74 (87.8%). Where ICG was used without PTB, the bilateral detection rate was 14/18 (77.8%) and the side-specific detection rate was 32/36 (88.9%). Where ICG was used with PTB, the bilateral detection rate was 14/19 (73.6%) and the side-specific rate was 33/38 (86.8%). Where PTB was used alone, the bilateral detection rate was 8/9 (88.9%) and the side-specific detection rate was 14/16 (87.5%).
The node positive rate was 2/76 (2.6%), both micro-metastases were discovered in SLN biopsy of two patients who went on to receive adjuvant therapy. One other patient with node-negative disease received adjuvant therapy.
Conclusion Sentinel lymph node dissection with ICG or PTB in cervical cancer is acceptable and feasible in our cohort as an alternative to full surgical staging. We detected two micro-metastases that would not have necessarily been detected on routine pathology staining.
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