title: Indocyanine green and infrared fluorescence in detection of sentinel lymph nodes in endometrial and cervical cancer staging - a systematic review.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) mapping for endometrial (EC) and cervical cancers (CC) is a current technique that could provide benefits over traditional lymphadenectomy. Near-infrared (NIR) fluorescence imaging is a promising technique to perform this procedure. We conducted a systematic review of the evidence regarding the technique and the effectiveness of indocyanine green (ICG) during SLN biopsy, using robotic and laparoscopic assisted surgery and laparotomy.
  
  
  METHODS
  We conducted a computer literature search for published English language studies in humans using PubMed since January 2010 up to May 2015. The initial search came up with 17 articles, of which 10 articles used ICG as tracer in SLN biopsy in EC and CC.
  
  
  RESULTS
  422 patients were included in 10 studies, ranging from 1 to 227 patients. The main surgical approach used in ICG SLN biopsy was robotic-assisted surgery in 368 patients. Laparotomy was performed in 39 patients and laparoscopy in 15. The detection rate in SLN mapping using ICG ranged from 78% to 100% for cervical injection and from 33% to 100% for hysteroscopic injection. Sensitivity and negative predictive value (NPV) vary from 50% to 100% and 88% to 100%, respectively. The most common site of injection was the cervix (two quadrants); this technique is correlated with a high detection rate (ranging from 78% to 95%). The cervical submucosal and stromal injections were the most frequent sites used. No complications related to ICG administration were described.
  
  
  CONCLUSIONS
  NIR fluorescence imaging using ICG is performed in robotic-assisted surgery in laparoscopy and in laparotomy, being a feasible, safe, time-efficient and seemingly reliable method for lymphatic mapping in early stage of CC and EC. Although it has promising results in SLN mapping, randomized studies, with larger patient samples, are needed.
authors.affiliation: Department of Gynecology and Obstetrics of São João Hospital Centre, Falculty of Medicine, Oporto University, Oporto, Portugal. Electronic address: anabela_fmup@hotmail.com.
authors.forename: Anabela
authors.initials: A
authors.lastname: Rocha
authors.affiliation: Department of Gynaecology of Vall d'Hebran University Hospital, Barcelona, Spain.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Domínguez
authors.affiliation: Department of Onco Gynecologic and Breast Surgery, European Hospital of Georges-Pompidou, Paris, France; Faculté de Médecine, Paris Descartes, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lécuru
authors.affiliation: Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, Clermont Ferrand Cedex, France; Faculté de Médicine, ISIT - Universite d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
mesh_terms: D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D009367:Neoplasm Staging; D000071036:Sentinel Lymph Node / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*
chemical_list: D007208:Indocyanine Green
keywords: Cancer/carcinoma/neoplasms; Cervix; Endometrial or endometrium; Gynecologic; Indocyanine green; Sentinel lymph node