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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

Lührs, Oscar LU ; Ekdahl, Linnea LU orcid ; Lönnerfors, Céline LU ; Geppert, Barbara LU and Persson, Jan LU (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.

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organization
publishing date
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
2024-04-17 00:57:45
@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 &lt; 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}},
}