Indocyanine Green versus Radiotracer with or without Blue Dye for Sentinel Lymph Node Mapping in Stage >IB1 Cervical Cancer (>2 cm).

Di Martino, Giampaolo; Crivellaro, Cinzia; De Ponti, Elena; Bussi, Beatrice; Papadia, Andrea; Zapardiel, Ignacio; Vizza, Enrico; Elisei, Federica; Diestro, Maria Dolores; Locatelli, Luca; Gasparri, Maria Luisa; Di Lorenzo, Paolo; Mueller, Michael; Buda, Alessandro (2017). Indocyanine Green versus Radiotracer with or without Blue Dye for Sentinel Lymph Node Mapping in Stage >IB1 Cervical Cancer (>2 cm). Journal of minimally invasive gynecology, 24(6), pp. 954-959. Elsevier 10.1016/j.jmig.2017.05.011

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STUDY OBJECTIVE

To compare sentinel lymph node (SLN) mapping in women with cervical cancer stage >IB1 (tumor size >2 cm) using indocyanine green (ICG) versus the standard technique using radioisotope technetium 99m radiocolloid (Tc99m) radiotracer with or without blue dye.

DESIGN

European multicenter, retrospective observational study (Canadian Task Force classification II-2).

SETTING

Four academic medical centers.

PATIENTS

Ninety-five women with stage IB1 cervical cancer (>2 cm) who underwent SLN mapping with Tc99m with or without blue dye or ICG and radical hysterectomy.

INTERVENTION

The detection rate and bilateral mapping rate were compared between ICG and standard Tc99m radiotracer with or without blue dye. Lymphadenectomy was performed, and the false-negative rate was assessed.

MEASUREMENTS AND MAIN RESULTS

Forty-seven patients underwent SLN mapping with Tc99m with or without blue dye, and 48 did so with ICG. All patients underwent radical hysterectomy with or without bilateral salpingo-oophorectomy between 2008 and 2016. The overall detection rate of SLN mapping was 91.5% for Tc99m with or without blue dye and 100% for ICG. A 91.7% rate of bilateral migration was achieved for ICG, significantly higher than the 66% obtained with Tc99m with or without blue dye (p = .025). Nine of the 23 SLN-positive patients (39.1%) were diagnosed exclusively as a result of the ultrastaging used to identify micrometastases or isolated tumor cells only.

CONCLUSIONS

In advanced cervical cancer (stage IB1 >2 cm), the detection rate and bilateral migration rate on real-time fluorescent SLN mapping were higher with ICG than with Tc99m radiotracer with or without blue dye. SLN mapping and ultrastaging can provide additional information for nodal staging in advanced cervical cancer. In this setting, ICG is a promising tool for mapping, appearing less affected by higher disease stage compared with traditional methods.

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