Introduction/Background*The aim of this study is to report the pelvic and Para-aortic SLN detection with a dual technique of indocyanine green (ICG) injection and Technetium 99 (Tc99) into the cervix and uterine fundus, in patients with Endometrial Cancer (EC)
Methodology Unicentric Prospective Study. 47 patients underwent laparoscopic surgery for EC in our center (with previous confirmative biopsy) between January 2019 and December 2020. A Dual Tracer was used (radiocolloid Technetium 99 (Tc99) and Indocyanine green (ICG) in 47 patients and a Dual Injection was performed (cervical and fundal) in 28 patients.
Result(s)*The detection rates were: 95.7%/45/47) for pelvic SLNs (90.9% bilateral) in Tc99 injection and 100% (44/44) for pelvic SLNs (88.6%) for ICG tracer. A 6.38% (3) showed direct atypical drainage outside the standard field of pelvic lymphadenectomy (two presacral SLNs and one with direct drainage to common iliac artery). The para-aortic SLNs rate was 44.11% (15/34) for Tc99 tracer and 57.1% for ICG(16/28).
Overall rate of lymph node involvement was 10,6% (5/47). Macroscopic lymph node pelvic metastasis were found in 4 patients (8.5%) and in only 1 case (2.1%) microdisease in SLN was found. A 30.7% (4/13) who para-aortic SLN was not detected, had infiltration of para-aortic lymphadenectomy. Two of them had also pelvic SLNs infiltration. There was a 4.2% positive para-aortic lymphadenectomies with negative pelvic lymph nodes.
Conclusion*The SLNs biopsy with dual tracer and dual injection (cervix and fundus) offers good overall detection and could increase para-aortic detection compared with cervical injection alone. When SLNs is not detected in para-aortic area we should complet the lymphadenectomy because in our study the rate of positive lymphadenectomy is not negligible (30%). A dual tracer could help in the ICG learning curve and ensure that the right SLN is removed.
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