Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99mwith blue dye versus indocyanine green fluorescent dye.
OBJECTIVE
The aim of this study was to compare technetium radiocolloid (Tc99m) + blue dye (BD) versus Indocyanine green (ICG) fluorescent dye in terms of the overall detection rate and bilateral sentinel lymph node (SLN) mapping in patients with endometrial carcinoma.


METHODS
Patients from five European centers with apparently confined clinical stage I endometrial cancer were reviewed. A comparison was made between women who received SLN mapping with pelvic and/or aortic lymphadenectomy (LND), and women who underwent SLN algorithm (SA), was also performed between the two groups.


RESULTS
Three hundred and forty-two (342) women were involved (147 in the Tc99m+ BD group and 195 in the ICG group). The overall detection rate of SLN biopsy was 97.3% (143/147) for women in the Tc99m+ BD group and 96.9% (189/195) for women in the ICG group (p = 0.547). The bilateral mapping rate for ICG was 84.1%-significantly higher with respect to the 73.5% obtained with Tc99m+ BD (p = 0.007). No differences in overall sensitivity (OS) and overall false negative rate (FNR) were seen between LND and SA (p value = 0.311), whereas the negative predictive value (NPV) was in favor of SA group (p value = 0.030).


CONCLUSIONS
In this study, fluorescent mapping using ICG resulted equivalent to the standard combined radiocolloid and BD, but real-time SLN mapping achieves a higher bilateral detection rate. The added value that this fast emerging technology promises to give certainly warrants future studies to further consolidate the advantages there are over the standard technique.
Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland.
Andrea
A
Papadia
Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
Ignacio
I
Zapardiel
Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Beatrice
B
Bussi
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
Fabio
F
Ghezzi
Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery International School of Surgical Anatomy Sacred Heart Hospital, Negrar, Verona, Italy.
Marcello
M
Ceccaroni
Department of Medical Physics, San Gerardo Hospital, Monza, Italy.
Elena
E
De Ponti
Department of Nuclear Medicine, San Gerardo Hospital, Monza, Italy.
Federica
F
Elisei
Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland.
Sara
S
Imboden
Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
Begoña Diaz
BD
de la Noval
Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland.
Maria Luisa
ML
Gasparri
Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Giampaolo
G
Di Martino
Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain.
Javier
J
De Santiago
Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland.
Michael
M
Mueller
Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Francesca
F
Vecchione
Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Federica
F
Dell'Orto
Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. alebuda1972@gmail.com.
Alessandro
http://orcid.org/0000-0002-7093-6862
A
Buda
D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D010535:Laparoscopy; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D015609:Organotechnetium Compounds / Q000008:administration & dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy
D005456:Fluorescent Dyes; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C109881:dithio-bisphosphine tc99m; D007208:Indocyanine Green
Endometrial cancer; Fluorescence tracer; Laparoscopic surgery; Sentinel lymph node mapping