title: Indocyanine green fluorescence imaging of lymph nodes during robotic-assisted laparoscopic operation for endometrial cancer. A prospective validation study using a sentinel lymph node surgical algorithm.
abstract: OBJECTIVE
  A sentinel lymph node (SLN) strategy may have particular value in endometrial cancer (EC) because a therapeutic effect of lymphadenectomy per se is unproven. The aim was to evaluate indocyanine green (ICG) and near-infrared (NIR) fluorescence mapping using a surgical algorithm.
  
  
  METHODS
  From November 2012 through December 2015, women with apparently early stage EC underwent robot-assisted laparoscopic hysterectomy including ICG fluorescence SLN mapping following the Memorial Sloane Kettering Cancer Center (MSKCC) surgical algorithm.
  
  
  RESULTS
  Among 108 patients included, ≥1 SLNs was identified in 104 (96%), bilaterally in 84 (78%) and unilaterally in 20 patients (18%). Four patients failed SLN mapping. All SLN-positive patients had pelvic SLNs. Median number of nodes were 4.0 and 6.0 (p<0.001), when SLNs only and SLNs plus non-SLNs were removed, respectively. Lymph node metastases were detected in 17 patients (16%). One patient who failed SLN mapping had a non-SLN metastasis. The remaining 16 patients had metastases in SLNs, 12 in SLNs only and four in both SLNs and non-SLNs. Routine pathology detected 75% of patients with cancer positive SLNs while 25% were based on extended pathology. Lymph node metastases were found among 9% with low-, 11% with intermediate- and 32% with high-risk profiles, respectively.
  
  
  CONCLUSIONS
  We have reproduced the high total and bilateral SLN mapping using cervical ICG injection and NIR fluorescence. Practical application of the MSKCC algorithm allowed high lymph node metastasis detection in combination with a low extent of lymph node removal.
authors: Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Norway. Electronic address: bjorn.hagen@ntnu.no.
authors: Bjørn
authors: B
authors: Hagen
authors: Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway; Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway. Electronic address: marit.valla@ntnu.no.
authors: Marit
authors: M
authors: Valla
authors: Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Norway. Electronic address: guro.aune@ntnu.no.
authors: Guro
authors: G
authors: Aune
authors: Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Norway. Electronic address: merethe.ravlo@stolav.no.
authors: Merethe
authors: M
authors: Ravlo
authors: Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway. Electronic address: abuslandannebritt@gmail.com.
authors: Anne Britt
authors: AB
authors: Abusland
authors: Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Norway. Electronic address: elisabeth.araya@stolav.no.
authors: Elisabeth
authors: E
authors: Araya
authors: Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Norway. Electronic address: marit.sundset@stolav.no.
authors: Marit
authors: M
authors: Sundset
authors: Section of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, Norway. Electronic address: solveig.tingulstad@ntnu.no.
authors: Solveig
authors: S
authors: Tingulstad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007208:Indocyanine Green; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology* / Q000601:surgery; D061848:Optical Imaging; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D019265:Spectroscopy, Near-Infrared; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Endometrial cancer; Fluorescence imaging; Indocyanine green; Robotic hysterectomy; Sentinel lymph node; Surgical algorithm