title: Laparoscopic Sentinel Node Mapping in Endometrial Cancer After Hysteroscopic Injection of Indocyanine Green.
abstract: To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping.
  
  
  
  Prospectively collected data (Canadian Task Force classification II-2).
  
  
  
  Gynecologic oncology referral center.
  
  
  
  Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping.
  
  
  
  The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed.
  
  
  
  A total of 57 procedures was performed. Patient mean age was 60 years (range, 28-80) and mean body mass index was 28.2 kg/m2(range, 19-43). At least 1 SLN was detected in 89.5% of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95% DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1-8), and in 47% of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5% of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67%) had aortic SLN involvement. No adverse events were reported.
  
  
  
  Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic.
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: fabio.martinelli@istitutotumori.mi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Department of Anesthesiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Edward
authors.initials: E
authors.lastname: Haeusler
authors.affiliation: Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007208:Indocyanine Green; D007267:Injections; D010535:Laparoscopy; D008875:Middle Aged; D010052:Ovariectomy; D011446:Prospective Studies; D058994:Salpingectomy; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Detection rate; Endometrial cancer; Hysteroscopy; Indocyanine green; Laparoscopy; Sentinel lymph node