Near-infrared Fluorescence-guided Sentinel Node Mapping of the Ovary With Indocyanine Green in a Minimally Invasive Setting: A Feasible Study.
Sentinel lymph node (SLN) mapping has increased its feasibility in both early-stage cervical and endometrial cancer. There are few SLN studies regarding the ovary because of the risk of tumor dissemination and perhaps because the ovary represents an inconvenient site for injection. In this preliminary study, we have shown the feasibility of SLN mapping of the ovary with indocyanine green during laparoscopic retroperitoneal aortic surgical staging. The 10 women who were included in this study underwent aortic with pelvic laparoscopic staging, which included SLN biopsy, extrafascial total hysterectomy, and bilateral salpingo-oophorectomy in case of an ovarian tumor. The fluorescent dye was injected on the dorsal and ventral side of the proper ovarian ligament and the suspensory ligament, close to the ovary and just underneath the peritoneum. In all cases except 1, SLNs were detected soon after the injection in the aortic compartment and in 3 cases also in the common iliac region. Only 1 intraoperative complication occurred: a superficial lesion of the vena cava that was recovered with a laparoscopic suture. Laparoscopic ovarian SLN mapping performed by means of an injection of indocyanine green fluorescent tracer in the ovarian ligaments seems feasible and promising. Further investigation are encouraged and necessary to evaluate the possible applications of this new technique for staging patients with early-stage ovarian cancer.
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy. Electronic address: ginoncmonza@gmail.com.
Alessandro
A
Buda
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy.
Paolo
P
Passoni
Department of Surgical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
Giacomo
G
Corrado
University of Milano-Bicocca, Monza, Italy.
Beatrice
B
Bussi
Department of Surgical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
Giuseppe
G
Cutillo
University of Milano-Bicocca, Monza, Italy.
Sonia
S
Magni
Department of Surgical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
Enrico
E
Vizza
D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000494:pharmacology*; D010535:Laparoscopy / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery; D061848:Optical Imaging / Q000379:methods; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D010053:Ovary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery
D007208:Indocyanine Green
Laparoscopic surgery; Ovarian lymphatic drainage; Real-time fluorescence; Sentinel lymph node