Combining Indocyanine Green and Tc99-nanocolloid does not increase the detection rate of sentinel lymph nodes in early stage cervical cancer compared to Indocyanine Green alone
(2019) In Gynecologic Oncology- Abstract
Objective: To investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer.
Methods: Consecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc99-nanocolloid (Tc99), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc99 or SLN-Tc99. In FIGO-stage ≥IA2 cancers a full pelvic lymph node... (More)
Objective: To investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer.
Methods: Consecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc99-nanocolloid (Tc99), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc99 or SLN-Tc99. In FIGO-stage ≥IA2 cancers a full pelvic lymph node dissection (PLND) was performed after detection of SLNs. The primary endpoint was the SLN detection rate per tracer and combination of tracers. Secondary endpoints were sensitivity and mapping rates of the SLN algorithm per tracer and combination of tracers.
Results: In the sixty-five analyzed women, the bilateral mapping rate was 98.5% for ICG and 60% for Tc99 (p < 0.01). Combining the tracers did not increase the bilateral detection rate. In three women (5%) Tc99 identified ICG-negative non-metastatic SLNs without impact on the bilateral detection rate. Eight women (12%) had lymph node metastases (LNMs), all had at least one metastatic SLN. Seven (35%) of the 20 metastatic SLNs were detected by ICG only and 12 (60%) were ICG and Tc99 positive.
Conclusion: SLN detection rate was significantly higher using ICG compared with Tc99. ICG identified all patients with LNMs. Combining ICG and Tc99 did not improve the bilateral detection rate of SLNs.
(Less)
- author
- Lührs, Oscar LU ; Ekdahl, Linnea LU ; Lönnerfors, Céline LU ; Geppert, Barbara LU and Persson, Jan LU
- organization
- publishing date
- 2019-11-26
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cervical cancer, Indocyanine green, Radiotracer, Sentinel lymph node biopsy
- in
- Gynecologic Oncology
- publisher
- Academic Press
- external identifiers
-
- scopus:85076042078
- pmid:31780237
- ISSN
- 0090-8258
- DOI
- 10.1016/j.ygyno.2019.11.026
- language
- English
- LU publication?
- yes
- id
- 78610297-6bbf-424c-9999-d498a3df2cab
- date added to LUP
- 2020-01-02 14:47:07
- date last changed
- 2024-07-24 10:43:09
@article{78610297-6bbf-424c-9999-d498a3df2cab, abstract = {{<p>Objective: To investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer. </p><p>Methods: Consecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc<sup>99</sup>-nanocolloid (Tc<sup>99</sup>), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc<sup>99</sup> or SLN-Tc<sup>99</sup>. In FIGO-stage ≥IA2 cancers a full pelvic lymph node dissection (PLND) was performed after detection of SLNs. The primary endpoint was the SLN detection rate per tracer and combination of tracers. Secondary endpoints were sensitivity and mapping rates of the SLN algorithm per tracer and combination of tracers. </p><p>Results: In the sixty-five analyzed women, the bilateral mapping rate was 98.5% for ICG and 60% for Tc<sup>99</sup> (p < 0.01). Combining the tracers did not increase the bilateral detection rate. In three women (5%) Tc<sup>99</sup> identified ICG-negative non-metastatic SLNs without impact on the bilateral detection rate. Eight women (12%) had lymph node metastases (LNMs), all had at least one metastatic SLN. Seven (35%) of the 20 metastatic SLNs were detected by ICG only and 12 (60%) were ICG and Tc<sup>99</sup> positive. </p><p>Conclusion: SLN detection rate was significantly higher using ICG compared with Tc<sup>99</sup>. ICG identified all patients with LNMs. Combining ICG and Tc<sup>99</sup> did not improve the bilateral detection rate of SLNs.</p>}}, author = {{Lührs, Oscar and Ekdahl, Linnea and Lönnerfors, Céline and Geppert, Barbara and Persson, Jan}}, issn = {{0090-8258}}, keywords = {{Cervical cancer; Indocyanine green; Radiotracer; Sentinel lymph node biopsy}}, language = {{eng}}, month = {{11}}, publisher = {{Academic Press}}, series = {{Gynecologic Oncology}}, title = {{Combining Indocyanine Green and Tc<sup>99</sup>-nanocolloid does not increase the detection rate of sentinel lymph nodes in early stage cervical cancer compared to Indocyanine Green alone}}, url = {{http://dx.doi.org/10.1016/j.ygyno.2019.11.026}}, doi = {{10.1016/j.ygyno.2019.11.026}}, year = {{2019}}, }