title: From Conventional Radiotracer Tc-99(m) with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach.
abstract: The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99(m)) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG).
  
  
  
  Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99(m) with BD.
  
  
  
  Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99(m) with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99(m) with BD; this difference was statistically significant (p < 0.0001).
  
  
  
  The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. ginoncmonza@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.affiliation: Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Papadia
authors.affiliation: Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zapardiel
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.affiliation: Department of Medical Physics, San Gerardo Hospital, Monza, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: De Ponti
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Andrea Alberto
authors.initials: AA
authors.lastname: Lissoni
authors.affiliation: Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Imboden
authors.affiliation: Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Diestro
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Verri
authors.affiliation: Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Gasparri
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Bussi
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Di Martino
authors.affiliation: Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
authors.forename: Begoña Diaz
authors.initials: BD
authors.lastname: de la Noval
authors.affiliation: Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Technomed Foundation, University of Milano-Bicocca, Monza, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Crivellaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005060:Europe; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D009367:Neoplasm Staging; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D005456:Fluorescent Dyes; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C109881:dithio-bisphosphine tc99m; D007208:Indocyanine Green