Introduction/Background Sentinel lymph node (SLN) mapping is recommended for lymph node staging in uterine confined endometrial cancer . The index study is one of the first in India to compare two types of injection techniques for SLN mapping : Combined fundal ICG + cervical Tc99m versus cervical Tc99m.
Methodology Prospective comparative interventional study was conducted in VPS Lakeshore Hospital, Kerala from April 2021 to Dec 2022 . 60 patients with uterine confined endometrioid carcinoma endometrium were allocated to group A which underwent combined fundal ICG + cervical Tc99m (n=30) and group B which underwent cervical Tc99m (n=30). Primary outcome was sentinel node detection rate . Secondary outcomes were sensitivity, specificity, positive predictive value, negative predictive value and correlation of risk factors for a positive sentinel node. Data was assessed using Statistical Package for Social Sciences (SPSS) version 21.0.
Results Overall sentinel node detection rate was 100% in both groups . Bilateral sentinel node detection was better in group A than group B : 93.33% vs 73.33% (p = 0.08) . Paraaortic sentinel detection rate was significantly better in group A (30%) than group B (3.33%) (p=0.012). SLN metastasis were diagnosed in 3/60 patients (5%) . The significant risk factors for SLN metastasis on univariate analysis were LVSI (p=0.005), LUS involvement (0.002) and cervical stromal invasion (p=0.01). On multivariate analysis these risk factors were not significant. On subgroup analysis, sensitivity, specificity, PPV and NPV of SLN biopsy in group A was 100%, 100%, 100%, 100% respectively. Specificity and NPV in group B was 100% and 100% respectively.
Table showing the comparative analysis between group A ( fundal ICG+ cervical Tc99m) and group B ( cervical Tc99m)
Conclusion Combined fundal ICG plus cervical Tc99m has better bilateral pelvic and paraaortic SLN detection rates. Risk factors for SLN metastasis on univariate analysis were LVSI, LUS involvement and cervical stromal invasion. However multivariate analysis showed no significance.
Disclosures There is no conflict of interests between the authors.
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