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Original research
Sentinel lymph node mapping with indocyanine green using SPY-PHI in open radical hysterectomy or trachelectomy
  1. Maria A Fernandez1,2,
  2. Helen D Clark3,
  3. Maria D Iniesta4,
  4. Mark F Munsell5,
  5. Michael Frumovitz4 and
  6. Pedro T Ramirez6
  1. 1Medicine Department, Universidad del Norte, Barranquilla, Atlántico, Colombia
  2. 2Executive and Continuing Professional Education (ECPE) – Principles and Practice of Clinical Research (PPCR), Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  3. 3Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
  4. 4Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  5. 5Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Maria A Fernandez, Universidad del Norte, Barranquilla, Atlántico, Colombia; mfernandezc23{at}gmail.com

Abstract

Objective To evaluate the detection rate of at least one sentinel lymph node (SLN) in patients with early cervical cancer who underwent open radical hysterectomy or trachelectomy using indocyanine green (ICG) with the SPY Portable Handler Imager (SPY-PHI) system.

Methods We retrospectively reviewed patients with cervical cancer FIGO 2018 stage IA1 with lymphovascular invasion up to stage IIIC1p who underwent SLN mapping and open radical hysterectomy or trachelectomy from March 2018 through August 2022 at The University of Texas MD Anderson Cancer Center. ICG was the only tracer used with the SPY-PHI system. Patient demographics, surgical approach, and tumor factors were analyzed. Overall detection, bilateral detection, and empty lymph node packet rates were determined.

Results A total of 106 patients were included. Ninety-four (88.7%) patients underwent open radical hysterectomy and 12 (11.3%) open radical trachelectomy. Median age was 40 years (range, 23–71). Median body mass index was 28.8 kg/m2 (range, 17.6–48.4). The most common FIGO 2018 stages were IB1 (35%) and IB2 (30%). The most common histologic subtypes were squamous cell carcinoma (45%) and adenocarcinoma (45%). Most patients had grade 2 disease (61%) and no lymphovascular invasion (58%). Median tumor size was 1.8 cm (range, 0.3–4). Median number of detected SLN was 4 (range, 0–12). An SLN was identified during surgery in 104 patients (98%), with bilateral mapping in 94 (89%) and unilateral mapping in 10 (9%). The empty lymph node packet rate was 4 (3.8%). The external iliac (73%) was the most common site of SLN detection. Fourteen patients had positive lymph nodes (13.5%); 3 (21.4%) had macrometastases, 9 (64.3%) had micrometastases, and 2 (14.3%) had isolated tumor cells.

Conclusion SLN mapping using ICG with the SPY-PHI system in open radical hysterectomy or trachelectomy is reliable and results in high overall and bilateral detection rates in patients with early cervical cancer.

  • Sentinel Lymph Node
  • Cervical Cancer
  • Hysterectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ijgc-2023-004787

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @hdaifotisclark, @frumovitz, @pedroramirezMD

    • Contributors MAF contributed to the study design, data analysis, manuscript writing, revision, and editing. HDC contributed to data collection and manuscript editing. MDI contributed to data collection and analysis, manuscript revision, and editing. MFM contributed to data analysis, manuscript revision, and editing. MF contributed to manuscript revision and editing. PTR contributed to study design, data collection and analysis, manuscript writing, revision, and editing and was responsible for the overall content as a guarantor. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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