Introduction Recently, open radical hysterectomy in early-stage cervical cancer has been preferred after the LACC trial was published. Also, the role of sentinel lymph node (SLN) mapping is increasing in the surgical treatment of cervical cancer. We evaluated the feasibility of SLN mapping by intra-abdominal indocyanine green (ICG) injection during open surgery for cervical cancer.

Methods This single-center, retrospective study included all patients who underwent intra-abdominal SLN mapping followed by radical surgery (including hysterectomy and trachelectomy) and systematic pelvic lymphadenectomy at Asan Medical Center. The novel intra-abdominal SLN technique was conducted with injection of 2 mL of 0.5 mg/mL ICG into either side between isthmus and cervix after dissection of bladder peritoneum. SLN was detected using the SPY Portable Handheld Imager (Stryker, Kalamazoo, Michigan, US).

Results From June 2020 to April 2023, eighty-five patients, newly diagnosed FIGO 2018 stage IA1 to IIIC1p cervical cancer who underwent open radical hysterectomy or trachelectomy, were included in this study. Of these patients, 78 (91.8%) underwent radical hysterectomy and 7 (8.2%) underwent radical trachelectomy. The SLN detection rate was 98.8% (84/85), with 83.5% (71/85) bilateral detection. All the frozen pathology results were consistent with the final pathology, with 15 (17.6%) patients who had nodal metastasis. Intra-abdominal SLN mapping achieved the sensitivity of 100% and the negative predictive value (NPV) of 100%.

Conclusion/Implications Intra-abdominal SLN mapping with ICG seems to be a feasible and reliable technique in patients with cervical cancer who are planned to undergo open radical surgery.