title: Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer.
abstract: OBJECTIVE
  Our study objective was to determine feasibility and mapping rates using indocyanine green (ICG) for sentinel lymph node (SLN) mapping in early-stage cervical cancer.
  
  
  METHODS
  We performed a retrospective review of all women who underwent SLN mapping with ICG during primary surgical management of early-stage cervical cancer by robotic-assisted radical hysterectomy (RA-RH) or fertility-sparing surgery. Patients were treated at two high-volume centers from 10/2012 to 02/2016. Completion pelvic lymphadenectomy was performed after SLN biopsy; additionally, removal of clinically enlarged/suspicious nodes was part of the SLN treatment algorithm.
  
  
  RESULTS
  Thirty women with a median age of 42.5 and BMI of 26.5 were included. Most (90%) had stage IB disease, and 67% had squamous histology. RA-RH was performed in 86.7% of cases. One patient underwent fertility-sparing surgery. Median cervical tumor size was 2.0cm. At least one SLN was detected in all cases (100%), with bilateral mapping achieved in 87%. SLN detection was not impacted by tumor size and was most commonly identified in the hypogastric (40.3%), obturator (26.0%), and external iliac (20.8%) regions. Five cases of lymphatic metastasis were identified (16.7%): three in clinically enlarged SLNs, one in a clinically enlarged non-SLN, and one case with cytokeratin positive cells in an SLN. All metastatic disease would have been detected even if full lymphadenectomy had been omitted from our treatment algorithm, CONCLUSIONS: SLN mapping with ICG is feasible and results in high detection rates in women with early-stage cervical cancer. Prospective studies are needed to determine if SLN mapping can replace lymphadenectomy in this setting.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Beavis
authors.affiliation: Texas Oncology, San Antonio, Texas, USA; University of Monterrey, San Pedro Garza Garcia, Mexico.
authors.forename: Sergio
authors.initials: S
authors.lastname: Salazar-Marioni
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Abdulrahman K
authors.initials: AK
authors.lastname: Sinno
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Stone
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Fader
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA; Texas Oncology, San Antonio, Texas, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan-Gomez
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: etanner4@jhmi.edu.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Tanner
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*
chemical_list: D007208:Indocyanine Green
keywords: Cervical cancer; Fluorescence imaging; Indocyanine green; Robotic hysterectomy; Sentinel lymph node