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Triple tracer (blue dye, indocyanine green, and Tc99) compared to double tracer (indocyanine green and Tc99) for sentinel lymph node detection in endometrial cancer: a prospective study with random assignment
  1. Roy Kessous1,
  2. Jeffrey How2,
  3. Jeremie Abitbol2,
  4. Sanam Puzhakkal2,
  5. Liron Kogan2,
  6. Amber Yasmeen2,
  7. Shannon Salvador2,
  8. Walter H Gotlieb2 and
  9. Susie Lau2
  1. 1Department of Obstetrics and Gynecology; Faculty of Health Sciences, Soroka University Medical Center; Ben-Gurion University of the Negev, Beer-Sheva, Israel
  2. 2Division of Gynecologic Oncology, Jewish General Hospital - McGill University Faculty of Medicine, Montreal, Québec, Canada
  1. Correspondence to Dr Walter H Gotlieb, McGill University Jewish General Hospital, Montreal, QC H3T1E0, Canada; walter.gotlieb{at}mcgill.ca

Abstract

Objective Sentinel lymph node (SLN) mapping is increasingly being used in the treatment of apparent early-stage endometrial cancer. The aim of this study was to evaluate whether three tracers (blue dye, indocyanine green (ICG), and technetium-99 (Tc99)) performed better than two (ICG and Tc99).

Study Design Prospective study of all consecutive patients (n=163) diagnosed with clinical early-stage endometrial cancer from 2015 to 2017. All patients were randomly assigned to receive a mixture of ICG and Tc99 with or without blue dye. Subgroup analysis for detection rates was performed for each group (double versus triple tracer).

Results One hundred and fifty-seven patients met the inclusion criteria. Eighty patients received ICG and Tc99 with unilateral and bilateral SLN detection rates of 97.5% and 81.3%, respectively. Seventy-seven patients received all three tracers with unilateral and bilateral detection rates of 93.5% and 80.5%, respectively. Only one patient in the triple tracer group was detected by blue dye alone. No significant differences were noticed in unilateral or bilateral detection rates between the two groups, nor in the detection of lymph node metastasis.

Conclusion The addition of blue dye to ICG and Tc99 did not demonstrate any improvement in SLN detection.

  • endometrial cancer
  • sentinel lymph node mapping
  • indocyanine green
  • blue dye
  • technetium
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Footnotes

  • Contributors RK: analysis and interpretation of data, drafting the article and revising it for submission, and approval of the version to be submitted. JH: acquisition of data, drafting the article and revising it for submission, and approval of the version to be submitted. JA: analysis and interpretation of data, revising the article for submission, and approval of the version to be submitted. SP: acquisition of data, revising the article for submission, and approval of the version to be submitted. LK: interpretation of data, revising the article for submission, and approval of the version to be submitted. AY: interpretation of data, revising the article for submission, and approval of the version to be submitted. SS: conception and design, acquisition of data, interpretation of data, revising the article for submission, and approval of the version to be submitted. WHG: conception and design, acquisition of data, interpretation of data, drafting the article and revising it for submission, and approval of the version to be submitted. SL: conception and design, acquisition of data, interpretation of data, drafting the article and revising it for submission, and approval of the version to be submitted.

  • Funding This work was supported by grants from the Montreal-Israel Cancer Research Fund, the Gloria Shapiro Fund, the Anne Marie and Mitch Garber Fund, and the Susan and Jon Wener Fund.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Hospital Institutional Research Board (Protocol #2019-1536).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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