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Abstract
Introduction/Background In endometrial cancer (EC) lymph node staging is of importance for adjuvant treatment planning and prognosis. Preoperative radiology with computed tomography (CT) or conventional magnetic resonance imaging (MRI) are not sufficient for lymph node staging. Previous studies in malignant melanoma and breast cancer have shown improved detection of metastatic lymph nodes with superparamagnetic iron oxide-enhanced MRI (SPIO-MRI).
The objective of this study was to investigate if SPIO-MRI can localize the sentinel lymph nodes (SLN) compared with fluorescence detection using indo-cyanine green (ICG) in robotic surgery in EC. A secondary objective was to evaluate if SPIO-MRI can predict metastatic lymph nodes in EC.
Methodology Patients with EC of high-risk with no preoperative signs of extrauterine disease, referred to a tertiary center for primary surgery, were enrolled. After a baseline pelvic MRI, SPIO (Magtrace), was injected in the cervix and pelvic SPIO-MRI was performed after 4-12 hours. Robotic surgery was performed with cervical injection of ICG for SLN mapping. Surgery included hysterectomy, bilateral salpingo-oophorectomy and bilateral SLN from iliaca externa, obturator and/or common iliac and presacral area. The sites of the SLNs were systematically described in a protocol at surgery, by the radiologist reading the SPIO-MRI and at the histopathological analysis, which included ultrasectioning and immunohistochemistry of the SLN and detection of iron.
Results Nine patients were included. All SLNs (N=32) indicated by ICG and retrieved at surgery were preoperatively identified by SPIO-MRI. Histopathology revealed iron staining in all SLNs. Two SLNs contained macrometastases (>2mm), five SLNs had micrometastases (0.2-2mm) and two SLNs were found to have isolated tumour cells (ITC).
SPIO-MRI showing bilateral iliac external nodes with iron-uptake in a patient with endometrial cancer
Conclusion This proof-of-concept study shows that SPIO-MRI may be feasible for preoperative localisation of SLNs in EC. Our findings need to be further explored in future studies with larger series.
Disclosures None