Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies☆
Section snippets
Background
The importance of sentinel lymph node (SLN) mapping in the prognostication of cancer was first described over a half century ago and has since been incorporated into the routine management of various solid tumor types [1], [2], [3], [4]. In gynecologic cancer, the SLN concept is most accepted for vulvar carcinomas, as seen with the publication of Gynecologic Oncology Group (GOG) protocol 174 and the Groningen international study on sentinel nodes in vulvar cancer (GROINSS V-1) [5], [6], [7].
Methods
Institutional review board approval was obtained for this retrospective study. All consecutive cases planned for SLN mapping using fluorescence imaging from 12/2011 to 4/2013 were identified and prospectively entered into our database, which is maintained for quality assurance purposes for all our robotic cases. Intracervical ICG was the fluorophobe used in all cases. The concentration used was 1.25 mg/mL. For each patient, a 25 mg vial with ICG powder was diluted in 20 cc of aqueous sterile
Results
Two hundred twenty-seven patients with endometrial or cervical cancer were identified. The median age of the patients was 60 years (range, 28–90 years), median BMI was 30.2 kg/m2 (range, 18–60 kg/m2), and median EBL was 50 cc (range, 5–1000 cc). The majority of patients (138/227, 61%) were diagnosed with grade 1 or 2 endometrioid adenocarcinoma of the uterus. The median surgical time to complete the SLN mapping was 30 min with some cases being mapped within 3 min (range, 3–84 min). The median number of
Discussion
The use of SLN mapping in the management of melanoma and breast cancers has become the standard of care [1], [2], [3], [4]. SLN mapping for uterine and cervical malignancies has been gaining acceptance and may offer a potential alternative to full LND in the future [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32]. Optimization of detection techniques and rates, with a goal toward convenience,
Conflict of interest statement
Dr. Leitao is a surgical proctor and consultant for Intuitive Surgical.
Dr. Jewell is a consultant for Intuitive Surgical and Covidien.
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Presented as an oral plenary at the 2013 Society of Gynecologic Oncology Annual Meeting on Women's Cancer in Los Angeles, CA.