title: Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer.
abstract: OBJECTIVE
  With the debate over extent of lymphadenectomy in endometrial cancer, sentinel lymph node (SLN) mapping may provide a focused approach to evaluate the most relevant lymph nodes (LN) while minimizing the complications. We evaluated SLN mapping using filtered technetium(99), indocyanine green (ICG), and blue dye.
  
  
  METHODS
  Prospective evaluation of 100 patients who underwent SLN mapping by using submucosal and deep stromal cervical injections of technetium(99), ICG, and blue dye as part of the staging for endometrial cancer.
  
  
  RESULTS
  286 SLNs were mapped (2.9 per patient) in 92% of patients. The bilateral detection rate was 76%. ICG had a significantly higher SLN detection rate than blue dye in both overall (87% vs 71%, respectively; p=0.005) and bilateral (65% vs 43%, respectively; p=0.002) detection, but similar SLN detection rates compared to technetium(99) in both overall (87% vs 88%, respectively; p=0.83) and bilateral (65% vs 71%, respectively; p=0.36) detection. In eight cases, the SLN was in the para-aortic area and in 14 cases in the pre-sacral, hypogastric vein, or parametrial area. In nine cases, the SLN was positive for metastasis, and in seven cases the SLN was the only positive node. One SLN was falsely negative. No complications or anaphylactic reactions occurred.
  
  
  CONCLUSIONS
  Intra-operative SLN mapping using cervical injection is feasible in patients with endometrial cancer and yields adequate detection rates. It allows mapping of SLNs in areas (pre-sacral, hypogastric vein, parametrial) not routinely sampled. Given the poorer performance of blue dye, surgeons may omit its use if a combination of ICG and technetium(99) is used.
authors: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: J
authors: J
authors: How
authors: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada. Electronic address: walter.gotlieb@mcgill.ca.
authors: W H
authors: WH
authors: Gotlieb
authors: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: J Z
authors: JZ
authors: Press
authors: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: J
authors: J
authors: Abitbol
authors: Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: M
authors: M
authors: Pelmus
authors: Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: A
authors: A
authors: Ferenczy
authors: Department of Nuclear Medicine, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: S
authors: S
authors: Probst
authors: Division of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors: R
authors: R
authors: Gotlieb
authors: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: S
authors: S
authors: Brin
authors: Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
authors: S
authors: S
authors: Lau
mesh_terms: D004396:Coloring Agents / Q000008:administration & dosage; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid; D007208:Indocyanine Green
keywords: Blue; Endometrial cancer; Indocyanine green; Sentinel lymph nodes; Technetium; Uterine cancer